Chances for hepatitis-B infection in adults to turn chronic and run its deadly course is about five percent Simply, over 90 percent or nine in 10 adults infected through sex or through open wounds, mucus membranes, or infected bites will likely get rid of the virus spontaneously sans any form of treatment. That also means not all hepatitis-B patients need to be treated, specifically adults who got infected as adults.

    Dr. Jaime Ignacio, vice president of the Philippine Society of Gastroenterology, stressed this point in his discussion "Beyond HBV Screening: The Value of Prevention."

    The virus can be ruthless on patients who were infected at childhood or perinatally-and about 40 percent of infections are transmitted from infected mother to the fetus. Such a patient's chances of undergoing through the four phases of the disease range from 95 percent to 100 percent. Most of the work and resources ought to be channeled for their benefit.

    Most patients do not show symptoms of the disease. Most of them will see their doctor after a routine medical screening-prior to employment in a local firm or deployment as OFW-shows they are hepatitis-B surface-antigen positive.

    Sadly, very little follow-up is given to them, too little explanation on what they have, the exact status of their infection, even some two-bit discussion on their possible treatment. There is little or no attention to their possible contacts-the spouse, the children, and other members of the patient's household who are equally vulnerable to the virus, he lamented.

    "They are ill and therefore deserve specific work-ups and specific treatment, if necessary. Screening is just the tip of the iceberg. It is the beginning of a long and arduous process," Ignacio noted.

    He says screening ought to include:

    o pregnant women;

    o patients engaged in high-risk sex (men who have sex with men, sex partners of HBV-infected persons);

    o injection drug users;

    o immunocompromised patients undergoing regular dialysis;

    o household members of HBV carriers;

    o persons exposed occupationally;

    o long-term inmates of correctional facilities or residents in institutions for the disabled; and

    o persons infected with hepatitis C or HIV.

    "Sonographic abnormalities that are routinely noted on executive checkups also should be screened along with blood and organ donors, patients with advanced liver disease, anybody who desires to be screened," he added.

    HBV infection can be likened to a hive or colony of termites in which surface antigens are workers running through the patient's bloodstream. Aside from these drones, there is also a queen or a form of HBV living inside the patient's body called the covalently closed circular form of the virus according to Ignacio.

    "It is the mother of the HBV infection that produces these drones or termites that make test results positive. It's difficult to treat and even with the available medication, we still are not ready to say that we are on the verge of a cure for this illness," Ignacio bewailed.

    The hepatitis-B surface test is the most common in use for initial screening of patients. Other markers should be employed:

    o The neutralizing antibody, the anti-HBs which reveals whether or not the infection is chronic;

    o Anti-HB4 shows whether the patient has been exposed before; and

    o Anti-HBS reveals a patient's immunity to HBV.

    As HBV is a DNA virus, the most important test to predict a patient's prognosis would be to zero in on the viral DNA which can reveal if the patient is at high risk for development of cirrhosis or liver cancer. In a study on about 3,600 patients in Taiwan, it was found out that the higher the hepatitis DNA, the higher the risk to liver cells. This transcends age, smoking history, and alcohol consumption, he said.

    If the individual tests positive for HBV, move on to second-phase testing, which includes ALT, ultrasound, and probably viral DNA test. The patient's contacts need to be tested, too.

    "There is no need for patients to be quarantined. What is needed is to protect the patient's household members by testing them and if they are positive, vaccinating them," he stressed.

    Capping his discussion, Ignacio pointed to the Taiwan experience in which general vaccination was adapted to curb spread of HBV infection. Results: incidence of the disease went down through the years and children's deaths from liver cancer went down as well. M