How To Be a Good Doctor

for The Great Family in Managing Hepatitis

Dr Agasjtya Wisjnu Wardhana SpPD KGEH FINASIM

Overview:
New WHO data reveal that an estimated 325 million
people worldwide are living with chronic hepatitis B
virus (HBV) or hepatitis C virus (HCV) infection.
The WHO Global hepatitis report, 2017 indicates that
the large majority of these people lack access to life-
saving testing and treatment. As a result, millions of
people are at risk of a slow progression to chronic liver
disease, cancer, and death.
[21 APRIL 2017 | GENEVA, AMSTERDAM]
Increasing mortality& new
infections
Viral hepatitis caused 1.34 million deaths in 2015, a
number comparable to deaths caused by tuberculosis
and HIV. But while mortality from tuberculosis and
HIV has been declining, deaths from hepatitis are on
the increase.
 Although overall deaths from hepatitis are increasing,
new infections of HBV are falling due to increased
coverage of HBV vaccination among children, the
report maintains. Globally, 84% of children born in
2015 received the three recommended doses of
hepatitis B vaccine
 The report notes that just 9% of all HBV infections and
20% of all HCV infections were diagnosed in 2015. An
even smaller fraction 8% of those diagnosed with
HBV infection (1.7 million people) were on treatment,
and only 7% of those diagnosed with HCV infection
(1.1 million people) had started curative treatment
during that year.
 HBV infection requires lifelong treatment, and WHO
currently recommends the medicine tenofovir, already
widely used in HIV treatment.
 Hepatitis C can be cured within a relatively short time
using the highly effective direct-acting antivirals.
 WHOs Global Hepatitis Report 2017 aims to provide a
starting point for hepatitis elimination by indicating
baseline statistics on HBV and HCV infections,
including mortality, and coverage levels of key
interventions
 Indonesia:
HBV infection is still quite prevalent in East Asia
and Southeast Asia, including Indonesia (2.5%-
10%). The endemicity of hepatitis B (marked by
HBsAg positivity) in Indonesia is intermediate to
high with geographical differences. HBV has been
classified into at least 9 genotypes (A through H
and J) and has been shown to have a distinct
geographical distribution.

HCV infection
 The risk for chronic infection is related to the
age at infection; for instance, approximately
90% of infected infants become chronically
infected compared with 2%-6% of adults.In
addition to HBsAg, HBeAg is an important
hepatitis B marker in the field of mother-to-
child transmission. HBeAg is a small secretory
antigen that can cross the placenta from the
mother to the fetus
 A specific community with maintenance hemodialysis
(HD) is at high risk for blood-borne infections,
especially HBV. However, few studies have been
conducted on the prevalence of HBV among HD
patients in Indonesia, and adequate databases on
HBV infection in this population are still limited.
(World J Gastroenterol. 2016 Aug 28; 22(32): 7264
7274.Published online 2016 Aug 28.)
Major problem:
Primary care physicians' approach to diagnosis and treatment of
hepatitis B and hepatitis C patients .

BACKGROUND:
Infections caused by hepatitis B virus (HBV) and
hepatitis C virus (HCV) are considered to be important
health problems worldwide. The purpose of this study
was to measure the general practitioners (GPs)' basic
knowledge on HBV and HCV risk factors in
determining their practice about this subject.
 CONCLUSION:
GPs' knowledge about risks of viral hepatitis was
adequate in this study. They were not able to diagnose
and follow up of these infections at PHCCs because of
limited knowledge about chronic viral hepatitis and
diagnostic facilities. GPs should be informed about
current advice in diagnosis and treatment of chronic of
HBV and HCV infections.
BMC Gastroenterol. 2004 Feb 6;4:3.
 Hepatitis B virus (HBV) infection may impose an
economic burden to patients or their families. The
prevention and control of HBV could effectively reduce
the burden. However, the management of HBV-related
patients has not been well controlled in China. With
the development of general practitioner (GP) system
in this country, GPs may greatly improve the
management of the patients with HBV infection.
However, the role of GPs in controlling HBV infection
has been rarely studied.
 The reports on the role of GPs in the prevention,
diagnosis and treatment of HBV infection are few. But
the experiences from Western countries demonstrated
that GPs could play a significant role in the
management of patients with CHB.
Role of community
Promotion : global awarenes
Prevention : pre exposure immunization
Education : post exposure infection
Role of Primary Care
Screening
Vaccination
Early detection for chronic infection
Monitoring
Referral involvement
What should we know:
Towards the Elimination of Hepatitis B and C by 2030
The draft WHO Global Hepatitis Strategy, 2016-2021
and global elimination targets
 What should we do :
Elimination
Vision A world where viral hepatitis transmission is
stopped and everyone has access to safe, affordable
and effective treatment and care
Elimination as a public health issue of concern -
remove sustained transmission, remove hepatitis as a
leading cause of mortality
Elimination and not eradication: long wave of
prevalence will remain for decades
Conted
Technically feasible by scaling up six key
interventions to high coverage
Key interventions for scale up
Hepatitis B vaccination (including birthdose)
Safe injection practices and safe blood
Harm reduction for injecting drug users
Safer sex (including condom promotion)
Hepatitis B treatment
Hepatitis C cure