Why the gay community in Nigeria should be concerned about hepatitis

Hepatitis B Virus (HBV) belongs to a group of viruses called hepatotropic viruses which cause inflammation of the liver, destroy liver architecture as well as impair its function. Other viruses in this group include Hepatitis C, A, D and E Viruses. Of all the members of the group, Hepatitis B (HBV) is the most notorious and a for good reason too. It is the most infectious and easily transmitted of the Hepatitis viruses being 50-100 times more infectious than HIV. It also affects the most number of people, with an estimated 350 million people worldwide being affected by the virus of which 1 million die annually from Hepatitis related liver disease. A study in Nigeria showed that about 19 million people were infected with HBV. All the Hepatitis viruses are capable of causing acute infections-short term infection of the liver which might resolve by itself or with treatment. Hepatitis B is however infamous for its ability to cause acute, chronic as well as fulminant hepatitis.

The virus can be transmitted from person to person through contact with body fluids majorly parenterally. Common modalities of transmission include sharing of sharp objects including needles for IV drug abusers, mother to child transplacental transmission, blood transfusion, and sexual intercourse.

Gay, bisexual and men who have sex with men have a higher chance of getting viral hepatitis including Hepatitis A, C, and E.

20% of all new cases of HBV in the US is among gay and bisexual men. A person can not get HBV infection from food, hugging an infected person, sharing eating utensils, coughing sneezing, holding hands or light kissing. People at greater risk of contracting HBV Hepatitis include people with multiple sexual partners, men who have sexual contacts with other men, those who inject drugs and share needles, those exposed to blood on the job, infants to infected mothers, those who receive multiple blood transfusions or are on haemodialysis, however anybody can get HBV.

The symptoms of HBV infection at the initial stage are non-specific symptoms which are really problematic in a third world country like Nigeria where really few would visit the doctor’s for fever like symptoms but would rather take antimalarials. The first symptoms of Hepatitis B Infection include malaise, myalgia (muscle pain), arthralgia (joint pain), nausea, vomiting, anorexia, and generalized body weakness with or without diarrhea. These symptoms constitute what is called the prodromal phase where the infection has not yet caused damage to the liver and is commonly seen within 6 weeks to 3 months in acute infection. Other more specific symptoms which occur when there is ongoing affectation of the liver and in chronic HBV infection include jaundice (yellowing of skin, mucous membranes and the sclera of the eye), pain and tenderness-pain when palpating-in the right upper quadrant of the abdomen where the liver is located, passage of pale oily stools and pruritus (itching of the skin). The worst part of this condition is that many people can be asymptomatic-the person shows no symptoms and is unaware-while continuing to transmit the infection to others. Very commonly, in chronic infections, patients can be asymptomatic for 20-25 year before turning up with specific symptoms indicating liver damage.

The eventual manifestations of a person infected with HBV have variations. Acute hepatitis infection can occur which is usually less than 6 months and can sometimes be cleared by the immune system and other times progress to chronic infection which is prolonged and can lead to liver cirrhosis, portal hypertension with haemorrhoidal and variceal bleeding, cause liver cancer (primary liver cell carcinoma) and liver failure. The correlation between HBV infection and Liver cancer has long been established.

While we focus on HIV,-which also puts a person at risk of developing chronic hepatitis from an infection with HBV, we must know that hepatitis is also a serious health concern for gays, bisexual men, and MSM. This is even more distressing given the fact that testing for the Hepatitis viruses are still far from commonplace irrespective of the tendency of HBV and HCV to cause liver-related deaths, the ease with which they can be spread by an asymptomatic carrier and the already added burden of HIV on the community. I have spoken with people who have condomless sex but instead insist on regular HIV tests as a way of keeping safe. These people always seem oblivious of other sexually transmitted infections, especially the HBV and HCV. Condomless sex is still fairly popular among community members to the extent that a part of the goal of PrEP promoters is to target this population. Sexual practices such as rimming and performing fellatio after a raw anal sex are also easy ways for fecal-oral transmission for hepatitis viruses.

However, the good news is that HBV is a classic example of how much better prevention is compared to cure. There is a three-dose vaccination regimen for the virus that infuses antibodies against the virus which offers a 98% protection rate. The vaccine should normally be available at health centers in Nigeria. The HBV vaccine is recommended for all persons at risks who have not had the vaccine such as health workers and gay, bisexual and MSMs. Most health workers have been vaccinated but the same cannot be said of gays, bisexuals, and MSMs. Post Exposure Prophylaxis in the form of immunoglobulin taken within 72 hours after a needle prick or within 14 days of sexual contact with an infected person is also preventive. Other preventive methods include safe sexual practices, avoiding sharing objects such as needles, razors, nail clippers and even toothbrushes.

Chronic HBV Hepatitis cannot be cured but can be managed with Interferon α, Lamivudine, Entecavir or Adefovir dipivoxil.

Liver transplant is also a treatment option for HBV caused liver failure. Interferons cost far more than the income of the common Nigerian. Surgeries to correct some of the complications of viral hepatitis such as liver failure and liver cancer are equally expensive. Chronic HBV patients who are not aware of their infection until there is severe liver damage usually have high mortality rates in a country like Nigeria.

One big question, however, is when will LGBTQ organizations in Nigeria see HBV infection as a problem and begin to consider investing into mass vaccination for community members who are more at risk compared to other groups.

Written by Iques Leader.