Pedro L. Trigo

By Dr. Pedro L. Trigo*

When a city is under siege, its defenders will fight to the last man to protect their homes. No matter who wins in the end, one thing is for certain — the city itself will sustain significant damage, and perhaps even be left in ruins.

This is exactly what happens to the liver during a hepatitis B infection. The virus — a platoon of ugly little organisms that look like lumpy soccer balls — descends on the liver to nest inside it and multiply. Your liver’s natural defenses — the heroic immune cells  — leap into action, destroying the virus wherever it lurks. In many cases, your immunity prevails, but the real loser ends up being the liver itself, which is often demolished in the fighting. If the battle is prolonged (chronic infections can rage within your liver for the rest of your life), then the scarring builds up and transforms this marvelous, soft pink organ into a mottled, hardened wasteland. Its ability to filter and purify your blood stream will be greatly impaired, leading to cirrhosis, bloating and discoloration, and sometimes — cancer of the liver followed by death.

The WHO considers a hepatitis B infection rate of 7.5 per cent of any given population to be very high. In Vietnamese cities, the rate is somewhere between 8-10 per cent, and in the poor countryside, it can hover around 40 per cent.

Transmission of hepatitis B usually happens differently here than it does in Western countries. Overseas, the virus is most commonly spread by sexual contact — the virus spreads a hundred times easier than HIV during unprotected sex. In Việt Nam, as in many Asian countries, hepatitis B is an endemic condition associated with mother-to-child transmission during birth. It is also connected with hygiene-related concerns, as well as sex without protection.

The infection of babies and infants is more nefarious in many ways than it is in adults. An adult’s mature immune system responds swiftly to hepatitis B, setting off a war that drains the body of its strength and manifests in symptoms similar to influenza or dengue. An adult is very likely to overcome the infection in the end and fully recover from the disease. When a small child or baby gets hepatitis B, however, it’s a different story. There’s no battle; the virus simply enters the liver and sets up its occupation with minimal resistance, getting on quietly with the business of building its colony unnoticeable from the outside. It’s only years later — after the virus has invisibly laid waste to the entire liver — that symptoms start to manifest themselves, by which time it is often too late to save it. In many cases, the only remaining options are limited to undergoing a liver transplant (which is not available in Việt Nam) or simply waiting for the end.

So how can we fight back against hepatitis B? There is a vaccine. The Engerix B vaccine is like a punching bag that looks like the most sensitive area of the hepatitis B virus. The body uses it to train the immune cells to produce supersoldier antibodies capable of completely eradicating the invaders without sacrificing the liver.

A more passive immunization can also be achieved by directly administering complete antibodies as a serum — just as breastfeeding mothers can pass on their own antibodies for some infections (not including hepatitis) to their babies through their milk, while their babies’ immune systems are still developing.

Once hepatitis B progresses to the chronic phase without proper treatment, there is no going back. The only way ahead is to try to survive this infection. In such cases, the key is to discover the presence of the disease as soon as possible by undergoing testing.

Early on in the virus’s years-long struggle against your immune system within your liver, the organ will largely function as normal. It’s only in the very late stages of the conflict that the damage is too catastrophic for your liver to work at all. Early detection means that the condition can be managed.

While we can’t as yet remove the hepatitis B virus from your body completely, physicians can prescribe medicines to prohibit it from replicating itself and taking up arms again. If you are a chronic sufferer of this disease, you can still live a normal, healthy life by routinely taking this type of medication.

Make sure you’re up to date with your hepatitis B vaccinations and are immune to this infection, and if there is any doubt, please get tested for the presence of this insidious enemy in your liver. Late detection can be a very serious matter. FAMILY MEDICAL PRATICE

*Argentinian native Dr. Pedro L. Trigo received his MD with honours at the Universidad de Buenos Aires and completed further programmes at Pittsburgh University’s liver transplant unit.

Family Medical Practice was the first foreign-owned primary health careprovider in Việt Nam, and has consistently remained at the forefront of international-standard medicine since 1995. It offers extensive health care and emergency medical services nationwide to Vietnamese, expatriates and corporate customers.

For more advice on any medical topics, visit Family Medical Practice Hanoi at: 298 I Kim Mã, Ba Đình. Tel: (024) 3843 0748.  E: hanoi@vietnammedicalpractice.com.

FMP’s downtown Hồ Chí Minh City location is: Diamond Plaza, 34 Lê Duẩn, District 1; 95 Thảo Điền, District 2. Tel: (028) 38227848. E: hcmc@vietnammedicalpractice.com

FMP Đà Nẵng is located at 96-98 Nguyễn Văn Linh, Hải Châu District, Đà Nẵng. Tel: (0236) 3582 699. E: danang@vietnammedicalpractice.com