Hepatotropic Viruses: Hidden drivers of Nigeria’s hepatitis crisis

•Chronic Hepatitis B, leading cause of liver cancer in Nigeria

As Nigeria joins the global community to mark World Hepatitis Day on July 28, health experts are calling for urgent action to dismantle the financial, systemic, and social barriers slowing the country’s response to hepatitis, a deadly but often overlooked epidemic, VINCENT KURAUN reports.

DAMILOLA, the youngest of seven children and the only girl, grew up surrounded by love and laughter. Her culinary passion blossomed early, and by the time she was in her second year of medical school, she had already made a name for herself among her peers for her delicious meals.

But during a routine visit home, her life took a tragic turn. Shortly after breakfast with her family, Damilola experienced severe abdominal pain and shortness of breath. Her brothers rushed her to the emergency unit, where initial tests pointed to issues in the gallbladder. However, further scans revealed a severely enlarged liver. A biopsy soon confirmed the worst: hepatocellular carcinoma (HCC), a deadly liver cancer linked to chronic hepatitis B.

Although doctors initiated chemotherapy and scheduled a surgery, the operation revealed the cancer had spread to both liver lobes and her lungs. Damilola’s condition deteriorated rapidly, highlighting the devastating consequences of undiagnosed or untreated viral hepatitis.

According to the World Health Organisation (WHO), an estimated 20 million Nigerians live with chronic hepatitis B or C, making the country one of the most hepatitis-burdened in the world. Despite this staggering statistic, awareness remains low, testing rates are poor, and access to treatment is severely limited.

The nature of hepatotropic viruses, particularly hepatitis B and C, makes the situation worse. These viruses can infect the liver silently for years, causing irreversible damage without noticeable symptoms until it is too late.

Understanding Hepatotropic Viruses

In an interview with the Sunday Tribune, a renowned histopathologist and hepatologist and Chief Medical Director of FUTA Teaching Hospital, Akure, Professor Olusegun Ojo, explained the complexity of viral hepatitis.

“Hepatitis simply means inflammation of the liver. The liver is a vital organ, second only to the heart in importance (if we are ranking them). It metabolises nutrients, detoxifies harmful substances, and supports immune functions,” he said.

“When the liver becomes inflamed, it poses a serious threat to the body,” explained Professor Ojo. “Inflammation can result from various factors such as alcohol intake, which leads to alcoholic hepatitis, or even metabolic disorders. But one of the most important causes is infection by microorganisms.”

“Among these microorganisms, viruses are the most significant. These are tiny, invisible agents, much smaller than bacteria like Staphylococcus or Streptococcus, and can’t be seen with a regular microscope. Despite their size, they’re capable of causing devastating diseases, including viral hepatitis.

“One group of viruses particularly harmful to the liver is known as hepatotropic viruses. ‘Hepatotropic’ means they have an affinity for the liver. That means, once in the body, they target and infect liver cells directly,” he said.

Professor Ojo identified five major hepatotropic viruses as hepatitis A, B, C, D, and E, which have varying modes of transmission and disease severity.

“The first step in diagnosing viral hepatitis is to identify the specific virus causing the inflammation,” Professor Ojo explained. “Hepatitis A and E are primarily transmitted through contaminated food or water, making them faeco-oral infections. These types are more common in tropical regions like Nigeria, where poor food hygiene, inadequate water supply, and substandard waste disposal make transmission easier.”

He added: “Hepatitis A is generally mild and often mistaken for malaria. Many people recover without ever knowing they had it, and once infected, they develop lifelong immunity. Hepatitis E, though similar in transmission, can be dangerous for pregnant women and may cause death. While hepatitis E is uncommon in Nigeria, hepatitis A is widespread, as most Nigerians contract it at some point, often unknowingly.

“In contrast, hepatitis B, C, and D are transmitted through infected blood or blood-related tools like needles, knives, or scalpels. These are not faeco-oral but are spread parenterally through direct blood contact. They can also be transmitted sexually or from mother to child during childbirth.

“Hepatitis B and C are particularly dangerous because they can lead to chronic infections. Unlike A and E, which usually resolve without lasting damage, B and C may persist for life in about 10 per cent of patients, potentially causing long-term liver damage and serious complications.”

Silent Killer on the Prowl

Professor Ojo underscored the serious threat posed by hepatitis B in sub-Saharan Africa, including Nigeria, where it remains a major public health issue.

“Hepatitis B causes both acute infections, which are sudden and severe, and chronic infections that can last a lifetime and lead to fatal liver disease,” he said. He noted that hepatitis D, an incomplete virus, only occurs alongside hepatitis B, making B the dominant problem in Nigeria.

On the current prevalence, he revealed that “between 8 and 10 per cent of the general population in Nigeria may test positive for hepatitis B.”

Among high-risk groups such as doctors, nurses, and surgeons, the figure can climb as high as 40 per cent due to occupational exposure. The virus is primarily spread through contaminated blood, reused needles or scalpels, and from mother to child during childbirth.

Although hepatitis C exists in Nigeria, its prevalence is under 4 per cent and lower when compared to Western countries and North Africa. Hepatitis D remains uncommon locally. “Whichever way we look at it, it’s crucial to acknowledge that hepatitis B is a serious viral infection in our country,” Professor Ojo warned.

He explained that acute hepatitis B can result in serious illness or even death, while chronic cases, seen in about 10 per cent of infected individuals, can silently spread the virus. Chronic carriers may unknowingly transmit it through blood donations, surgical tools, or childbirth.

To curb the spread, he emphasised the need for rigorous screening of health workers. “Anyone treating patients must be screened for hepatitis B to prevent infecting others,” he said, adding that chronic hepatitis B continues to be a major driver of transmission in Nigeria, affecting 8 to 10 per cent of the population.

Responding to questions about symptoms and diagnosis, Professor Ojo explained that acute hepatitis B can present dramatically with symptoms such as fever, fatigue, jaundice, and even abnormal bleeding. “Those who survive acute infections may develop chronic hepatitis, which is often asymptomatic,” he said. Many patients with chronic hepatitis B appear healthy and only discover their status during routine tests, often questioning the diagnosis because they feel fine.

He stressed that diagnosis relies heavily on screening, particularly the hepatitis B surface antigen test, which is widely available in hospitals, labs, and even clinics.

“When I say 8 to 10 per cent of Nigerians are infected, that figure comes from population-level testing. In fact, the Federal Ministry of Health estimates prevalence may be as high as 13 per cent,” he noted. Pregnant women are especially encouraged to test, as vertical transmission to the baby is a major concern.

Blood donation centres also routinely screen for hepatitis B to ensure safety. “If someone tests positive, even without symptoms, they must not dismiss it,” Professor Ojo warned. “The virus can silently damage the liver over time and lead to serious complications.”

He advised anyone who tests positive to seek specialist care. “Find a hospital with a liver specialist, a hepatologist or gastroenterologist, who can assess the severity of infection and recommend treatment,” he said. Antiviral treatments are available that can effectively manage hepatitis B and reduce the risk of liver failure or cancer.

Costly Diagnosis and Treatment

Despite the availability of effective antiviral drugs, treatment remains out of reach for most Nigerians.

Explaining this, a gastroenterologist at Obafemi Awolowo University Teaching Hospital, Professor Dennis Ndububa, told Sunday Tribune that tenofovir and entecavir are potent oral drugs for managing hepatitis B, but they often require lifelong use. Pegylated interferon, another treatment option, is less popular due to severe side effects and cost.

“For hepatitis C,” he added, “treatment is even more promising. Direct-acting antivirals (DAAs) like sofosbuvir, daclatasvir, velpatasvir, ledipasvir, etc. offer cure rates above 95 per cent after just 12 weeks. These drugs are available in Nigeria but must be paid for out-of-pocket as they are not covered by the National Health Insurance Scheme (NHIS).”

Both experts lamented the lack of low awareness of hepatitis among the Nigerian populace, the high cost of diagnosis and treatment of viral hepatitis and the lack of political will as major obstacles towards the elimination of hepatitis. They added that despite the development of national guidelines, strategies, and training modules such as National Strategic Framework, National Guidelines for the Treatment and Control of Viral Hepatitis, and Training Modules for healthcare workers and the collaboration between government and NGOs like the UNODC, Clinton Health Access Initiative (CHAI), Jhpiego, Yakubu Gowon Centre, Abbott Laboratories among others, implementation has been weak.

Professor Ndububa cited several challenges to include limited access to specialists, exclusion of hepatitis treatment from NHIS, lack of prevention of mother-to-child transmission (PMTCT) in many birth centres and the failure to integrate hepatitis care into existing HIV/AIDS programmes.

Explaining the consequences of the delivery of babies in unorthodox centres in many parts of Nigeria, he said: “Most babies born in such locations are not likely to receive the birth dose of hepatitis B vaccine, which is pivotal in breaking the hepatitis B virus transmission.”

“Only 25.5% of people who tested positive for hepatitis B in a study knew their status,” he revealed. “Meanwhile, over 72% knew their HIV status. Hepatitis simply doesn’t get the same public attention.”

“However, while the guidelines and training modules are available, efforts at combating hepatitis have been hampered by a lack of political will on the side of the government to take ownership of the hepatitis treatment and control programme. There is hardly any budget line for hepatitis funding in Nigeria,” he added.

Corroborating Professor Nduduba on the most effective tools in the fight against hepatitis B, Professor Ojo stated that every newborn in Nigeria should receive the birth dose of the hepatitis B vaccine, ideally within 24 hours of birth.

“Additionally, anyone who tests negative should be vaccinated to prevent infection. This is especially important for those working in hospitals or in high-risk populations. For example, medical students should be vaccinated when entering their clinical years in medical school. Also, babies born to mothers who are hepatitis B positive should be vaccinated as soon as it’s feasible,” he added.

To the general public, he said, “Everyone should get tested for hepatitis B as it is prevalent in our population. At some point, everyone needs to be aware of their status because if you are positive, you should not ignore it.   

“If you are negative, it is crucial to get vaccinated. Don’t just assume you are safe. If there’s an accident where you may need emergency care, you could inadvertently be exposed to hepatitis B.”

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