T Lemley, A Burke, O Simwale
T Lemley, A Burke, O Simwale. Hepatitis In Primary Care: What Physician Assistants Can Do To Help Save Million Of Lives. The Internet Journal of Academic Physician Assistants. 2005 Volume 5 Number 1.
As millions of infected patients, friends and families commemorate May as hepatitis awareness month, we invite Physician Assistants to reflect on their role as frontline custodians for the health millions of people currently infected or likely to be infected by the seemingly silent epidemic of hepatitis C. Approximately 1 in 50 people in the general population are positive for HCV antibodies1, and about 1 in 20 patients seen in primary care may have acute or chronic hepatitis C
Background And Discussion
Viral hepatitis (A, B or C) combined affects 5 to 20% of our population1, 3,5. The consequences of hepatitis are significant. Although most cases of hepatitis A resolve spontaneously, each year a hundreds of patients (especially adults) develop liver failure from hepatitis A. For example, during the Chi-chi's outbreak of 2003 in Pennsylvania, over 601 hepatitis A infections were associated with the epidemic over a period of three weeks, of whom 124 were hospitalized, 1 required a liver transplantation and 3 died1,11. Hepatitis B infections usually resolve, especially when acquired in adulthood as is typical for the USA. However each year, 5% of adults develop chronic hepatitis B, and about half of these develop fulminant liver failure leading to death in the absence of liver transplantation1,2,3. Furthermore, there remains the risk of vertical transmission from mother to infant particularly in those chronic carriers with active viral replication. Infants who have hepatitis B are more than 90% likely to become chronic carriers and as many as 1000 to 5000 cases per 100,000 person years (1-5% per year)risk developing hepatocellular carcinoma (HCC) and 25% will die of liver cancer or cirrhosis5. Both hepatitis A and B are vaccine preventable but hepatitis C is not. Hepatitis C, leads to chronic infection in about 85% of patients, with approximately 15-20% of patients developing cirrhosis or HCC1,6 and it is the leading cause of liver transplantation in the US. Together hepatitis B and C are the main causes of HCC, the 8th most common type of cancer in the US3,4,5,6. About 50% of those infected with hepatitis C are undiagnosed and only as few as 2-15% of those for whom treatment is indicated actually receive it3,4,5,6,7. Yet, with currently available therapy, over 40% of patients completing therapy may expect sustained virological clearance – essentially cure. In patients with HIV, it is liver disease not AIDS which is killing the majority of HIV/HCV or HIV/HBV co-infected patients1,8. Although less responsive than HIV negative patients, HIV co-infected patients too may achieve viral clearance with appropriate therapy.
Physician Assistants can help reduce the burden of hepatitis by adopting two basic principles;
It is recommended that HCV positive patients be advised not to drink alcohol, use acetaminophen, start new meds without speaking to physician, donate blood or semen, share razors or toothbrush, use IV drugs or share paraphernalia. But you should, consult your physician, get an HIV test, contact support group, get a doctor or health department and be vaccinated against Hepatitis A & B, maintain healthy weight, control diabetes mellitus, consider treatment and remember sex is okay in monogamous relationships.
To repeat the opening statement – patients with viral hepatitis may be infectious and a risk to others, at risk of progressive liver disease themselves or candidates for therapy. Thus identifying these patients so that they may receive the optimum treatment and education is of paramount importance.
About the authors
Mr. Thomas, J. Lemley is an Assistant Professor at the in the Physician Assistant Program at Lock Haven University; Dr. Anne Burke is an Assistant Professor of Medicine in the Department of Medicine, University of Pennsylvania School of Medicine; Mr. Owen Simwale is an Epidemiology Research Associate and Hepatitis C Coordinator with the Pennsylvania Department of Health. Comments and questions can be sent to: firstname.lastname@example.org