Egypt's problem with the virus previously underestimated PARIS: As a transmitted infection, hepatitis B (HBV) is one of the strongest viruses in the world, said the doctors at the 12th International Symposium in Viral Hepatitis and Liver Disease, thus making it one of the greatest global health risks to date. "HBV is 100 times more infectious than AIDS and 10 times more infectious than hepatitis C, and that's why it is a very, very big problem, he explains. What makes it worse is that there is no cure. HBV is a major health problem worldwide. According to a presentation by A. Mele, from the Istituto Superiore di Sanita in Rome, Italy, entitled, "Hepatitis B virus infection, 25 years after the development of an effective vaccine, it is estimated that around 2 billion people are infected with HBV, 350 million have a chronic infection and 4 million new acute infections occur each year by way of HBV. Furthermore, HBV is responsible for more than 1 million deaths each year. What makes HBV so potent is the fact that it can live outside the body on a dry surface for more than a week, while other viruses, such as AIDS, die as soon as they leave the body. "Unlike the other forms of hepatitis, HBV can be transmitted through blood, sexual intercourse and through pregnancy, so a person with HBV can literally transmit it to anyone, says Dr. Gamal Esmat, professor of hepatology at Cairo University and president-elect of the International Association for the Study of Liver Disease. According to Dr. Shiha, because the virus can live outside the body, women give it to their children during labor because the virus is not contained in the placenta. Furthermore, a mother with HBV cannot breast feed safely, while a mother with HCV can. In Egypt, 25 percent of the general population has HBV, according to official statistics. In fact, of all existent forms of hepatitis, HBV is the most prevalent in Egypt. "Official statistics are not the real numbers, however, says Shiha. "In Egypt, we actually have close to 2 million people infected with HBV. According to Shiha, the Egyptian government does not want to acknowledge the severity of HBV infection in Egypt because in doing so they would have to subsidize the treatment, which is very expensive. Furthermore, the Egyptian government has been too busy looking at HCV to pay attention to the growing importance of HBV, said Shiha. "You show the government the statistics and the findings of your research and they say, what are you talking about? HBV is not a big problem in Egypt, states Shiha. The problem of HBV in Egypt can be traced back to the methods of testing for the virus. For more than 10 years, Egypt was testing for HBV using machinery known as BDNA branching, which only detected HBV in a person if they had more than 700,000 copies of the virus in his body. Because the machine was not sensitive enough, it could not detect those with less. "In the beginning, before using BDNA branching as a means of testing, we found many cases of HBV in the country - then, once we started using this method of testing, suddenly everyone who tested for HBV came out negative, so the country thought we had gotten rid of hepatitis B, says Shiha. "For more than 10 years, Egypt was depending on a machine that was wrong. Shiha first discovered the problem with BDNA branching in Egypt 10 years ago, when he sent a number of HBV samples to a prominent testing facility in the country at the time, which he declined to name. "In Egypt, the tests came back negative, which immediately alerted me that there was a problem as I knew that the samples contained HBV, he says. Shiha then sent an identical copy of the samples to the United States; the tests came back positive. BDNA branching contributed to the greater spread of HBV as people went about their lives without taking precautions because they thought they didn't have HBV, infecting more people in the process. While the country now uses a more advanced machine for testing, which detects HBV in a body with as few as 300 copies of the virus, it is too late for many. However, the government has redeemed itself on one front when it comes to HBV - in 1992 they introduced the HBV vaccine in their national infant immunization programs, albeit only children under the age of 15 can get the vaccine as part of the program, leaving a huge population of high risk teens susceptible. "Hepatitis B will always stay in the body. The objective of the treatment is to get people to live with it, like diabetes or high blood pressure, says Esmat. Simultaneously, a national campaign should be implemented to create awareness of the virus and to begin the process of eradicating it completely so that others do not get it or transmit it, he adds. "People ask, what is the point of treatment if it doesn't eradicate the virus? The point of treatment is to stop the virus from spreading and infecting others. In many cases, the treatment makes the viral load low, thus halting the virus from being strong enough to transmit, says Dr. Sherif Abdel Fattah, senior gastroenterology and hepatology me-emeritus, Military Medical Academy. If there is light at the end of the HBV tunnel, it's that the younger an individual is when they receive treatment for HBV, the greater their chances of having an acute form of HBV, rather than chronic, (acute HBV means that a person can contract the disease but the virus will be weak enough not to affect the body or the liver, while chronic HBV leads to serious health and liver issues). According to Abdel Fattah, 90 percent of those who receive treatment as children have acute cases of HBV, while 90 percent of those who get treatment as adults have chronic cases of HBV. According to the New England Journal of Medicine, five medications are available for HBV infection: Interferon Alfa, Lamivudine, pegylated Interferon alfa-2a, adefovir dipivoxil and entecavir. Unfortunately, most of them are not effective, with the exception of entecavir, which, according to current data, has proven to lower the probability of HBV reoccurrence as well as maintain low viral loads so that people with HBV can live without health complications.
