World Hepatitis Day - It’s Time for Action

30 July, 2024

Hepatitis is the term used to describe inflammation of the liver. It's usually the result of a viral infection or liver damage caused by drinking alcohol. There are several different types of hepatitis. Some types will pass without any serious problems, while others can be long-lasting (chronic) and cause scarring of the liver (cirrhosis), loss of liver function and, in some cases, liver cancer. (NHS, 2023)

With Sunday, July 28th, being World Hepatitis Day, we spoke with Arthur Goan, one of eight committee members of the RVH Liver Support Group. This non-profit organisation was founded about 25 years ago to help people and support all liver patients throughout Northern Ireland, irrespective of their liver condition. They have it can range from PSE, PBC, autoimmune hepatitis, viral hepatitis B, C and D or through the use of excess alcohol or non-alcoholic fatty liver disease which is caused by lifestyle choices.

They support those in the Royal Victoria Hospital by attending liver clinics in the outpatient department and visiting patients in 6D in the Regional Liver Unit.

They have also set up and created the Relative's Room, within the Regional Liver Unit, a quiet space where patients can go and have a cup of tea or coffee with their relatives or speak with their Drs or consultants in complete privacy. 

Arthur described the virus as being the guest and the host being the liver cell with the Hepatitis B and C viruses residing in the liver cells and multiplying so that the liver cell acts as protection for them. "When your immune system realises there is a foreign body there it will attack the virus but unfortunately to attack the virus it attacks that liver cell and it kills that liver cell." Over time more and more liver cells are killed off and become fibrotic. If this liver injury goes untreated and it continues, the tissue moves from fibrotic to cirrhotic which can be fatal as people with cirrhosis are susceptible to liver cancer.

"The liver performs over 500 different things every single day without you knowing it. Outside of the heart, it is the 2nd most important organ and it is the biggest organ in your body...It's the only organ that can regenerate itself if it's damaged in the early stages of liver injury, or liver fibrosis, but when it gets to cirrhosis, it can't. If you are going through those stages over a 10-year period and 15-year period, it gets to a point where your liver just says I can't do this anymore and you start to get jaundice, you start to get various other symptoms of like end-stage liver disease and then it's too late."

"That's why it's critically important for people to get diagnosed."

For the Liver Support Group, "the one big thing that isn't happening enough is that people aren't getting tested and were are finding more and more people who are being diagnosed, they are presenting themselves to the Royal when it is too late."

When asked about the importance of preventative diagnostic testing and treatment, Arthur stated that these were critically important with the Liver Support Group actively promoting early detection. For the Liver Support Group, raising awareness of the importance of testing, vaccines and treatments within the public domain is pivotal. Arthur explained that "anyone who thinks they have been infected, anyone who works in an environment where they possibly could be infected or any active gay men need to be aware of the virus. There is a vaccination for it but not everyone is aware of that. So for that cohort of people, it would be good for them to be tested regularly for the virus."

Arthur recalled an interaction with a young patient in which they were diagnosed with chronic active hepatitis and had been living undiagnosed for two to three years. "It makes me sad when I see a young guy like that coming in and he was diagnosed and he came to me and he said, "Arthur, am I going to die?" And I said, you're not going to die, you're in the safety net in the Royal Liver Unit now and you'll be fine, you know, you're one of the lucky ones. But there are so many other ones out there who aren't lucky. The latest statistic from the British Liver Trust is that there are about 200 thousand people in the UK with hepatitis B but that's the known ones, how many more? Hundreds of thousands are out there who don't know."

Arthur feels that this case could have been prevented had there been more accessible information out in the public domain about the virus (Hepatitis B), how it can severely damage the liver and how there is protection through vaccination. He went on to say "If you are infected and you have been diagnosed with the virus there are very effective treatments available so for us, the absolute key is being tested either through the GP network or the genitourinary clinics here in the Royal and then if you have the virus go on to get treated for it."

"Unfortunately, there are very few symptoms and in most cases there are none. For people who do begin to get symptomatic, they will have flu-like symptoms, they would have maybe jaundice or abdominal pain but in most cases, there are no symptoms. So people need to be, if they think at all that they might be infected, they need to get tested. And then the pathway is so much easier for them and if they don't then it's so much more difficult."

"I don't know how exactly but we need to get more information out into the public domain about it." When speaking about the video, posted on our social media, Arthur joked "That's the proper viral we like to hear about (TikTok viral), not the other one you know."

"The thing about it is, when we look at all the liver injuries here and the possible causes, hepatitis B is preventable. It's one that is preventable and there's not enough talk about it to make people aware."  Arthur stressed that anyone in the cohort of people he had mentioned previously "get tested and if they have the virus then there are lots of very very good treatments that they can live out their lives" with lifelong antiviral treatment.

"It's a real dangerous virus (Hepatitis B) as is Hepatitis C and the thing is unlike C there is a vaccination for it." Hepatitis B can be contracted through semen, blood and vaginal fluids whereas Hepatitis C can only be contracted through blood.  Almost 90% of hepatitis C cases in the UK occur in people who inject drugs or have injected them in the past. "Hepatitis B is more for gay men, and then people who are working in the areas like where I'm working who possibly could get infected. With Hepatitis C there is treatment now where the virus will be eradicated but you can get it again, that's the only thing. If you get rid of it and then continue taking drugs or whatever, then you can get infected again. Whereas Hepatitis B, if you get the vaccination then you're protected for life basically...Having said that, if you're not diagnosed with either B or C, it doesn't matter, they both end up, you end up in the same place. They both cause liver injury and liver damage."

As of autumn 2017, a hexavalent (6 in 1) vaccine replaced the previously used pentavalent (5 in 1) infant vaccines. All babies born on or after 1 August 2017 became eligible for this hexavalent vaccine, which includes hepatitis B (HepB) in addition to the other antigens or toxoids previously included in the pentavalent vaccines, for their primary immunisations.  (Hexavalent DTaP/IPV/Hib/HepB Combination Vaccine: Information for Healthcare Practitioners, 2024)

Arthur went on to say, "I'm on a panel with the public health agency and that panel has been set up to eradicate B and C by 2030."  "Hepatitis C, a couple of years ago used to be a death sentence. Back then if you had hepatitis C, you were going to die from it, you were going to get cirrhosis, there was no treatment, you were going to get cirrhosis you were going to get end-stage liver disease and die. Now, today, the medications that they have will get rid of hepatitis C in 9 out of 10 people. You get rid of the virus which is brilliant."

The RVH Liver Support Group's goal is to reach out to as many people as they can to help reduce the number of people being admitted to the Royal due to preventable causes. "Outside of the unpreventable causes like PBC and PBE and autoimmune hepatitis...where you can't help it and there's no cure for them, they are just treatment-based...there are a lot of preventable causes."  "The biggest portions of liver patients are in the preventable category so all of us are doing something wrong when most liver patients are in the preventable category. We've got to reduce that, that's one of our aims."

Ward 6D of the Regional Liver Unit has 25 beds, with Arthur adding, "Every one of them has a liver patient in them and it's always full." It pains Arthur to see that many of the cases could have been prevented if the right information had reached the right people.

He went on to say that the Liver Support Group work with a lot of alcoholics as well with alcoholism being another preventable cause. "I'm working with a few guys and two of them are homeless and people look down on them if they see someone on the street. But you gotta understand that there's a reason why they are there."

Arthur continues, "Binge drinking is really bad for your liver as it has to deal with all the toxins and getting rid of all those toxins...it becomes inflamed if it's fired a lot of alcohol over a short period of time and it can just give up (suffer from acute liver failure)."

Arthur recalled the loss of one patient in particular to acute liver failure caused by a weekend of binge drinking; "He wasn't a big drinker but he drank lots of rum and vodka and stuff over a weekend and I'm talking bottles and yeah he didn't make it."

"Drinking at any level is not good for your liver injury, it doesn't matter how little you drink it causes liver injury and you will always need a period of not drinking to help your liver recover you don't know that this is all happening but it is."

He then went on to explain another case he had seen in which a patient was diagnosed with F2 Fibrosis of the liver which was linked to alcohol.

The patient had said that they didn't take it at the weekend, but instead had "a glass and a half, maybe two glasses of wine for her dinner, Monday to Friday...No effect whatsoever, she was never drunk or had any feelings of pain in her abdomen or nothing but she was still at f2 fibrosis."

Arthur reemphasised that, "continuous liver injury even though you think it's mild, but it's still liver injury...This information is not getting out into the public domain and these are the sorts of things that need to be out there...people need to know if you are continuously drinking, even though you think it's not a lot it's still a lot for your liver if it's continuous."

Fortress Diagnostics offers a range of rapid diagnostic tests (RDTs) suitable for preliminary or emergency medical screening for use in medical facilities with limited resources and laboratories with low numbers of tests per day.

Rapid testing refers to diagnostic tests that provide quick results, often within minutes to a few hours, making them particularly valuable for timely decision-making in clinical and public health settings. These tests are designed for ease of use, minimal equipment requirements and quick turnaround times, making them suitable for point-of-care(POC) testing outside traditional laboratory settings.

Out of this range, Fortress Diagnostics offer 6 RDTs for the diagnostics of Hepatitis B & Hepatitis C along with various other diagnostic tests for Hepatitis A, B, C & E.

Hepatitis B virus (HBV) is an enveloped, double-stranded DNA virus belonging to the Hepadnaviridae family and is recognised as the major cause of blood-transmitted hepatitis together with Hepatitis C virus (HCV). Infection with HBV induces a spectrum of clinical manifestations ranging from mild, inapparent disease to fulminant hepatitis, severe chronic liver disease and in some cases that can lead to cirrhosis and carcinoma of the liver.

The Fortress Diagnostics Hepatitis testing range is intended for the quantitative detection of antibodies to hepatitis B in human serum or plasma. It is intended for use in the diagnosis and management of patients related to infection with the hepatitis B virus. 

Hepatitis C Virus is a small, enveloped, positive-sense, single-stranded RNA virus. HCV is now known to be the major cause of parenterally transmitted non-A, non-B hepatitis. Antibody to HCV is found in over 80% of patients with well-documented non-A, non-B hepatitis. Conventional methods fail to isolate the virus in cell culture or visualize it by electron microscope. Cloning the viral genome has made it possible to develop serologic assays that use recombinant antigens. Compared to the first-generation HCV EIAs using single recombinant antigens, multiple antigens using recombinant protein and/or synthetic peptides have been added in new serologic tests to avoid nonspecific cross-reactivity and to increase the sensitivity of the HCV antibody tests.

Fortress Diagnostics aim to make testing and diagnosis as direct and easily accessible as possible. Please see below for the wide range of Hepatitis testing products offered by Fortress Diagnostics.

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Explore the Fortress Rapid Test range here.