In this interview with ARUKAINO
UMUKORO, Dr. Joseph Onigbinde, an
infectious disease specialist and
professor of Public Health, New York
University, who is also the Managing
Director of Ropheka Medical and Dental
Hospital, speaks on the link between
Hepatitis B and HIV/AIDS
What is Hepatitis B?
Hepatitis simply means an inflammation
of the liver as a result of an infection or
virus. Hepatitis is a broad nomenclature.
There are different types, Hepatitis A, B,
C, D and E. A tends to be ‘fecco-oral’
mode of transmission. B and C are
similar to HIV mode of transmission. D
is a parasite, it infects only those that
have B, and E is similar to A. In my
organisation, we are interested in
Hepatitis B, which is about the most
dangerous among the types. Hepatitis
B, when fully blown, is dangerous
because most of the time, the infection
is not known until one is screened.
Hepatitis B causes terminal diseases
such as cancer of the liver, liver cirrhosis
and liver failure.
How prevalent is Hepatitis B in Nigeria?
Many studies have been done in Nigeria
by local scientists. In the last two years,
the Centre for Disease Control in
Atlanta, USA sent out some researchers
who have been doing research in the
country. They came out last year to say
the prevalence rate of Hepatitis B in
Nigeria was as high as 11 per cent. That
means if you extrapolate that with the
population of the country, close to 20
million Nigerians have it. There has
been an increase over the years. The
survey was presented to the Federal
Government in December last year. In
advanced countries, the prevalence rate
is hardly higher than two per cent. The
vaccine had long been developed as far
back as 1982. There are 280 million
people in the world who are chronic
carriers of Hepatitis B virus in their
liver. About two million of the carriers
die every year from liver cancer and
liver cirrhosis.
What is the mode of transmission?
One can get infected with Hepatitis B
the same way one can be infected with
HIV/AIDS; that includes through sex,
blood transfusion, body fluids and many
others way by which HIV/AIDS is
transmitted. When fully blown, Hepatitis
B is more dangerous than HIV. This is
because none of the complications of
chronic Hepatitis B infection can be
managed conservatively, but HIV/AIDS
can be. Although HIV still has no cure, if
one uses the drugs effectively, it could
help the infected person live a
prolonged life. But chronic Hepatitis B is
always catastrophic, either as cancer of
the liver or liver cirrhosis. However, if
Hepatitis B is detected early, there are
drugs that can be used to manage it, but
they are very expensive.
How can Hepatitis B be prevented or
managed?
Prevention is through vaccination. Like I
said earlier, the vaccine has been
available since 1982. It has been
incorporated into the immunisation
scheme of the US. As a professor of
public health and director of Hepatitis
programme at New York University, I
led a team of medical researchers to
investigate the prevalence of Hepatitis B
among New York residents. To my
amazement, among over 20,000 people,
only five persons were positive. And
four out of five of them, or 80 per cent
of them, were Nigerians. The fifth
person was Togolese. So, it was an all-
African affair.
What is the relationship between
Hepatitis B and HIV/AIDS?
They are just like co-travellers because
their mode of transmission is similar.
Can someone contract Hepatitis B and
HIV at the same time?
Absolutely.
How can such cases be managed?
HIV and Hepatitis B can be managed
separately. But where there is co-
infection, such people have to be
treated more seriously. But it’s not
everyone with Hepatitis B that needs
treatment. There has to be a series of
medical tests to determine if the virus is
actually active in the body. The case has
to be investigated further before the
person is subjected to treatment. As
per HIV, tests include determining the
blood count, viral load and CD4 counts.
If the viral load is so heavy and the CD4
counts are very low, treatment should
be introduced immediately, especially
when the person has already shown
signs of AIDS.
Would you say Nigeria is winning the
war against HIV and Hepatitis B?
With due respect, I think Hepatitis B,
and generally Hepatitis infections, have
been neglected by the government and
many non-governmental organisations.
Everybody seems to have focused more
on HIV. I have been involved in HIV/
AIDS control programme since 1992,
and in 2003 I travelled to the US for the
International Visitors Programme on
HIV/AIDS and infectious diseases. The
programme was sponsored by the US.
To be fair to Nigeria, the prevalence rate
of HIV is declining, that means we are
winning the war. This is because people
are now more aware about HIV/AIDS
than Hepatitis B. It is now that people
are getting to know about Hepatitis B. A
year ago, when I asked 10 persons
whether they knew anything about
Hepatitis B, nine of them knew nothing
about it. But now, more people are
more aware. That is the thrust of our
organisation; to create awareness and
help reduce the prevalence rate in the
population, and how people can protect
themselves against it, as well as
screening themselves for it.
What should people know about
Hepatitis B?
Like I said, there should be more
enlightenment programmes to let
people know that Hepatitis B is very
deadly. One wouldn’t know one has the
infection without undergoing thorough
screening and tests. That is what we are
doing. There should be more vaccination
also, especially in rural areas. Seventy
per cent of people who give birth are in
the rural areas which lack such
healthcare. Since our primary healthcare
is in rural areas, if they incorporate the
Hepatitis B vaccination into their
healthcare programmes, it will reduce
the prevalence rate in the country.
What further advice would you give to
government and health authorities to
effectively contain Hepatitis B?
I would advise that more awareness
should be created through community-
based and faith-based organisations, as
well as the use of the print and
electronic media to campaign about it.
It is time we stepped up intervention
strategies.
Is there a particular age range that is
more prone to Hepatitis B?
Yes. People between 30 and 60 have a
lot of prevalence because they would
have been carrying the virus from an
earlier age. And it begins to manifest at
this prime of their lives.
What are the signs and symptoms of
Hepatitis B?
The signs and symptoms include
weakness, it may look like malaria and
typhoid cases. Sometimes, it doesn’t
show any sign, especially when it is in
the early stages. Later, it becomes too
late. The complications arising from
chronic infection of Hepatitis B can be
serious. And in many cases, one may
not know one is infected until he or she
is tested. That is why having a test is
very important.
What is the most effective way to curb
it?
Vaccination for children is the best way
to prevent it. But every age group can
be at risk and can be vaccinated to
prevent Hepatitis B infection.
What are the challenges your
organisation is facing in creating
awareness?
One of the challenges is lack of partners
to work with us. I would say that the
concept of NGO has been abused in this
country. Currently, we do not have
partners and it is difficult to move our
workers from one community to the
other. We need more partners to do the
work and see the importance of what we
are pioneering.
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