The ABCs of Hepatitis
Interviewed by Melissa Moniz
Wednesday - January 13, 2010
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Dr. Naoky Tsai
Medical director of the Liver Center and Liver Transplant Program at Hawaii Medical Center East
How long have you been practicing?
Since 1981.
What have been the biggest advances or changes in your field since you first began practicing?
There are several. No. 1, the liver transplant became available to people who are really sick and desperately need help to prolong their life in a healthy way. That’s one of the major accomplishments. There are two others, and one is the treatment for chronic Hepatitis C. Hepatitis C is a viral hepatitis that can cause cirrhosis of liver, liver failure, cancer and death. Since 1991 there is new treatment that has become available, but in the beginning it wasn’t very successful. In the beginning, we were only able to get about 10 percent of people cured. We now have, across the board, about a 50 percent cure rate. The third major advancement is the treatment for Hepatitis B. We have medication available now to control the virus. We cannot cure Hepatitis B like Hepatitis C, but we have medications to control it, pretty much like how we control high blood pressure, diabetes and cholesterol. If we control Hepatitis B well, people won’t die from liver cancer and failure.
How does someone get Hepatitis B and C?
Hepatitis B, this virus is basically transmitted most commonly from mother to child at the time of birth. Up to 80-90 percent of the time the baby will be infected. If they are infected at birth, then more than 90 percent of them will carry the virus for life. Some will die from liver disease and liver cancer. The second way, which is more common in developed countries, is sexual transmission. The third way, which is much less common, is sharing of dirty needles. The majority of Hepatitis B that we see here in Hawaii is mother-to-child transmissions, but that number is getting better now because we have vaccines. So all the mothers have to be screened.
For Hepatitis C, it’s mostly through transfusions or exposure to dirty needles. Sexual transmission is very rare. Hepatitis C was a major problem before 1992 because we didn’t have a way to screen blood for this virus, so the Hepatitis C virus could be transmitted through blood transfusions. We advise those who received a blood transfusion before 1992 to be checked for Hepatitis C. Mother-to-child transmission does occur, but it’s much less than Hepatitis B.
What are the symptoms of Hepatitis B and C?
Both Hepatitis B and C don’t have symptoms in the beginning, and that can go on for 30 to 40 years before you really get sick. By the time they get sick it’s actually too late. I tell my patients that it’s like termites: If your house has termites, you don’t know it in the beginning unless you look for it. Otherwise, the day you find out you have termites is when your house crumbles. That’s what we see quite a bit.
Prevention is the best policy, but early detection of any disease is the next best thing. So don’t rely on symptoms. The best policy is to go to a doctor for regular checkups, and if you are at high risk for hepatitis, then you should ask your doctor to screen for infection, and this screening is now covered by most medical insurances.
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What services are offered at the Liver Center at HMC East?
Historically, the Liver Center started when we started to do liver transplants here. The idea is that although transplant is a life-saving procedure, it is probably the last resort. What we are trying to do at the Liver Center is prevent a transplant from happening by intervening at an early stage. At the Liver Center, we do consultations and we manage patients who need to be treated. We do clinical trials to find new treatments, and we’ve been involved in it since 1991. So that’s another activity that we do. We are still conducting liver disease clinical trials, so we have a pretty big staff. We also recently got a grant from the National Institutes of Health to conduct Hepatitis B research. The federal government felt there is an unmet medical need in Hepatitis B treatment, particularly in Asian-Pacific Americans. The grant enables us to study it and find new treatments. In addition, recent reports from the National Cancer Institute showed that while all cancers in the U.S. have been declining, the liver cancer rate in this country has been increasing. In fact, Hawaii is No. 1 in the whole country in the instance of liver cancer and deaths. Because of this trend, we have organized a liver cancer and tumor committee to facilitate the care and treatment of these patients in Hawaii Medical Center East. And finally, we also have established a liver disease support group in the medical center.
Why is Hawaii No. 1 in the country in liver cancer and deaths?
We have a higher prevalence of chronic Hepatitis B.
Just to give you numbers, nationally the prevalence rate is 0.4 percent. We did a 4,000-people screening recently, and we found an almost 5 percent positive rate. We have about the same percentage of prevalence in Hawaii in terms of Hepatitis C as the rest of U.S. Nationally, Hepatitis C has been the leading reason for increasing liver cancer, and we have the most here in Hawaii. Increasing fatty liver disease due to obesity has started to contribute to the increasing liver disease and liver cancer here and around the country. We need to advocate and educate the public about this problem in order to stem this trend, and the Liver Center at Hawaii Medical Center East is in the forefront of this effort.
Are there any new breakthrough treatments or technology on the horizon?
Yes. The Liver Center is the only center of excellence for liver disease in Hawaii. We have a lot of referrals, and what the Liver Center wants to do is the whole spectrum of disease intervention starting from prevention. In the next three to five years, we will see a major advancement in the treatment of chronic Hepatitis C. The cure rate may increase to around 80 percent, and this will definitely put a dent on the rate of liver failure and liver cancer, and the need for liver transplantation. Another breakthrough treatment may come from the new treatments for liver cancer. We also have groundbreaking findings in the mechanism of liver scarring, which may translate to developing medications to stop cirrhosis. So there is hope in the fight against liver disease.
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