Hepatitis and liver cancer

Hepatitis causes inflammation of the liver and is most often caused by a virus, of which there are 6 types: hepatitis A (HAV), hepatitis B (HBV), hepatitis C (HCV), hepatitis D (HDV), hepatitis E (HEV), hepatitis G (HGV). All of these viruses affect the liver and have similar symptoms, however they are spread in different ways, have different treatments and have different long term affects. HAV, HBV and HCV are the most common types of hepatitis virus, with HBV and HCV infection being the biggest risk factors for liver cancer. In fact, hepatitis B and hepatitis C cause approximately 71% of liver cancer cases worldwide, with people infected with both HBV and HCV most at risk.

Hepatitis B
Hepatitis B is the most common liver infection in the world. HBV is spread through contact with infected blood, semen or other bodily fluids. During the first 6 months after infection it is considered to be 'acute' hepatitis. If hepatitis B virus (HBV) tests continue to be positive for more than 6 months after infection the affected person is considered to have 'chronic' hepatitis B. Up to 1 in 4 people with chronic hepatitis B will die from either liver cancer or liver failure due to cirrhosis unless they receive appropriate care and treatment. Chronic hepatitis B causes prolonged liver damage which may result in cirrhosis (liver scarring) and lead to liver cancer.

Worldwide, an estimated 257 million people have been infected with HBV, with approximately 887,000 deaths resulting from this viral infection in 2015. Almost 240,000 people have chronic hepatitis B in Australia, however there is thought to also be a large number of people in Australia living with hepatitis B that have not yet been diagnosed.

There has been a hepatitis B vaccine available since 1982, with the vaccination programme commencing in Australia in 1988. The vaccine provides over 90% protection against hepatitis B and is your best defence against this disease.

Hepatitis C
Hepatitis C is the other major type of viral hepatitis responsible for increasing your risk of liver cancer. Over 90% of cases in Australia are caused by HCV 1a and 1b (54% prevalence) and HCV 3a (37% prevalence) genotypes. The biggest risk of contracting HCV is from injecting drugs, particularly if you share needles or use dirty needles which may have come into contact with infected blood. Other potential sources of infection include unhygienic needles being used for tattooing or piercings, with an additional (yet smaller) risk of contracting HCV through unprotected sexual intercourse with an infected person. Hepatitis C can cause mild to serious illness, also with the potential to become chronic, cause cirrhosis and lead to liver cancer.

Globally, approximately 71 million people have chronic hepatitis C infection, with approximately 399,000 people dying each year. An estimated 230,000 people in Australia are currently living with hepatitis C infection.

There is currently no vaccine for HCV, however a number of preventative strategies are advised to tackle the issue of HCV infection. HCV can be treated relatively easily, with the current recommended treatment being direct acting antivirals (DAAs). DAAs have changed the therapeutic landscape for hepatitis C with an estimated 90% curative rate. However, HCV infection continues to have significant morbidity and mortality with traditionally less than 2% of affected Australians receiving treatment.

According to the an AIHW report on Cancer in Australia 2017, liver cancer has had the second highest percentage change in incidence rate of all cancers over the last 35 years with an increase of over 300%. Reducing viral hepatitis is a key step in reducing primary liver cancer.

Useful resources

Hepatitis Australia

WHO Hepatitis B fact sheet

WHO Hepatitis C fact sheet

Cancer council Victoria

Better Health Victoria

Cancer in Australia 2017

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