World Hepatitis Day, July 28 (1)

The burden of hepatitis B infection is highest in the WHO Western Pacific Region and the WHO African Region, where 116 million and 81 million people, respectively, are chronically infected. In 2019, hepatitis B resulted in an estimated 820 000 deaths, mostly from cirrhosis and hepatocellular carcinoma (primary liver cancer). Hepatitis B can be prevented by vaccines that are safe, available and effective.

Hepatitis C is an inflammation of the liver caused by the hepatitis C virus. The virus can cause both acute and chronic hep­atitis, ranging in severity from a mild illness to a serious, lifelong illness including liver cirrhosis and cancer. The hepatitis C virus is a bloodborne virus and most infections occur through exposure to blood from un­safe injection practices, unsafe health care, unscreened blood transfusions, injection drug use and sexual practices that lead to exposure to blood. Globally, an estimated 58 million people have chronic hepatitis C virus infection, with about 1.5 million new infections occurring per year. There are an estimated 3.2 million adolescents and children with chronic hepatitis C infection. WHO estimated that in 2019, approximately 290 000 people died from hepatitis C, mostly from cirrhosis and hepatocellular carcinoma (primary liver cancer). Antiviral medicines can cure more than 95% of persons with hepatitis C infection, but access to diagnosis and treatment is low. There is currently no effective vaccine against hepatitis C.

Hepatitis D virus (HDV) is a virus that requires hepatitis B virus (HBV) for its replication. Hepatitis D virus (HDV) affects globally nearly 5% of people who have a chronic infection with hepatitis B virus (HBV). HDV infection occurs when people become infected with both hepatitis B and D simultaneously (co-in­fection) or get hepatitis D after first being infected with hepatitis B (super-in­fection). In a study published in the Journal of Hepatology in 2020, conduct­ed in collaboration with WHO, it was estimated that hepatitis D virus (HDV) affects nearly 5% of people globally who have a chronic infection with hepatitis B virus (HBV) and that HDV co-infection could explain about 1 in 5 cases of liver disease and liver cancer in people with HBV infection. The study has identified several geographical hotspots of high prevalence of HDV infection including Mongolia, the Republic of Moldova, and countries in western and central Africa. Populations that are more likely to have HBV and HDV co-infection include indigenous populations, recipients of haemodialysis and people who inject drugs. Worldwide, the number of HDV infections has decreased since the 1980s, due mainly to a successful global HBV vaccination programme. The combination of HDV and HBV infection is considered the most severe form of chronic viral hepatitis due to more rapid progres­sion towards liver-related death and hepatocellular carcinoma. Hepatitis D infection can be prevented by hepatitis B immunization.

Hepatitis E is an inflammation of the liver caused by infection with the hepatitis E virus (HEV). Every year there are an estimated 20 million HEV infections worldwide, leading to an estimated 3.3 million symp­tomatic cases of hepatitis E. WHO estimates that hepatitis E caused approximately 44 000 deaths in 2015 (accounting for 3.3% of the mortali­ty due to viral hepatitis). The virus is transmitted via the fecal-oral route, principally via contaminated water.

Hepatitis E is found worldwide, but the disease is most common in East and South Asia. Prevention is the most effective approach against the infection. At the population level, transmission of HEV and hepatitis E infection can be reduced by maintain­ing quality standards for public water supplies and establishing proper dis­posal systems for human faeces. On an individual level, infection risk can be reduced by maintaining hygienic practices and avoiding consumption of water and ice of unknown purity.

Five types of viruses cause hepatitis, its attendant complications and chronic liver disease, most commonly hepatitis A virus (HAV), hepatitis B virus (HBV) and hepatitis C virus (HCV). Depending on the type, the viruses are transmitted by food, sex organs and blood, and may also cause co-infections. Vaccines against these viruses are not widespread. Treatment consists of administering immunomodulators (interferon) or nucleoside and nucleotide analogs, which can cause several side effects or result in drug resistance]. New antiviral strategies based on natural compounds are actively being pursued (Chojnacka et al. Antiviral Properties of Polyphenols from Plants. Foods 2021, 10, 2277.

Viral hepatitis infections trigger the production of reactive oxygen (ROS) and nitrogen(RNS) species. This is particularly true for infections caused by the blood-borne hepatitis viruses (B, C, and D), human immunodeficiency virus (HIV), influenza A, Epstein-Barr virus, respiratory syncytial virus, and other viruses. For acute respiratory viral infections, ROS/RNS have been implicated in lung tissue injury and epithelial barrier dysfunction which in turn increased the susceptibility to secondary infections. In case of chronic viral hepatitis, oxidative stress is known to promote liver fibrosis, cirrhosis, and cancer, as well as metabolic dysfunction.

Flavonoids, a subset of polyphenols use several mechanisms to inhibit and act on the viruses. They can obstruct the attachment and entrance of viruses into the cells, obstruct different phases of viral DNA replication, protein translation and poly-protein processing. They can also inhibit the viruses from being released to invade other healthy host cells. Flavo­noids can attach to the surface proteins of viruses, prohibiting the virus from entering the host cells. Some flavonoids act as a transcription blocker and affect the replication process while others hinder the late stages of viral assembly, packaging and release. Flavonoids can also modulate the immune system and reduce viral load.

A nutrient-rich diet can lessen the pos­sibility of chronic diseases and helps in making many viral infections less severe. There are functional foods laden with potent vitamins (vitamins A, D, C, E, B6, and B12), minerals (calcium and mag­nesium), trace elements (zinc, copper, selenium, etc.), carbohydrates, proteins, fats, and water. These multi-nutrients provide the highest nutritional value for all systems of the body, including bone, cardiovascular, liver, skin, and immune support. Therefore, eating a balanced diet rich in multi-nutrients can improve immunity against infections.

Cocoa is a notable functional food and a strong anti-oxidant. Cocoa con­stitutes a rich source of fiber (40-26%), lipids (24-10%), proteins (20-15%), carbohydrates (15%), and micronutri­ents (<2%) including minerals (P, Ca, K, Na, Mg, Zn, Cu) and vitamins (A, B, E). Cocoa also contains high amounts of methylxanthines (theobromine and small amounts of caffeine) and phenolic compounds named flavanols. Increasing cocoa consumption should be part and parcel of the collaborative efforts in reducing the burden of viral hepatitis in the country.#

By Dr Edward Ampofo

the Chief Pharmacist

Cocoa Clinic

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