Wednesday, 7 March 2012

Hepatitis C strike rate double that of HIV incidence in India

By Syed Akbar
Every year on October 1 scientists and health experts the world over rededicate themselves to 
the complex research on finding a vaccine for Hepatitis C. But  health reports reveal that this highly asymptomatic liver disease is fast spreading in India. October 1 is observed as world hepatitic c day.
A World Health Organisation report points out that Hepatitis C virus, often described as a "viral time bomb", has 
recouped with strength to strike  vigorously, two times more than that of the human immuno-deficiency virus or HIV. 
It has emerged as a silent killer in the country. The WHO lists India along with Egypt, Italy and Japan, where the 
HCV cases is rampant. The number of Hepatitis C patients in India equals if not exceeds the total number of HCV 
patients in Europe and the USA.
What  worries health planners in developing countries, particularly India, is that there is no vaccine as yet to prevent 
Hepatitis C. Other Hepatitis virus like A and B have vaccines to prevent the spread of the disease. In the absence of a 
vaccine, the best way to keep off Hepatitis C virus, is by simply following certain "prevention and precaution" steps.
Another worrying factor that came to light during the World Hepatitis Day on October 1 was that the Hepatitis C 
virus could not be prevented totally through the use of condom. This virus can be spread by sex. But the efficacy of 
latex condoms in preventing infection with Hepatitis C virus is unknown. Doctors, however, feel that proper use of 
condoms may reduce the transmission risk, though it will not totally eliminate it.
Vaccination against Hepatitis A and Hepatitis B may help in prevention of Hepatitis C to a large extent.
"Did you receive a blood transfusion, hemodialysis, angiogram, tatooing, prolong injections or syringes? If yes, get 
tested for Hepatitis C. Remember the cure rate is high if the infection is detected early. Pegylated interferon can 
affect a cure in good number of patients," says senior gastroenterologist Dr Dharmesh Kapoor.
WHO health reports indicated that as against 5.1 million Indians suffering from HIV/AIDS, around 12 million 
Indians are suffering from Hepatitis C. That the disease is poised to spread fast in developing countries is evident 
from the fact that eight out of 10 people do not have access to safe blood. Moreover, about 30 per cent of HIV 
patients also simultaneously suffer from Hepatitis C.
The Indian Journal of Gastroenterology reports that about three per cent of people in Andhra Pradesh are infected by 
Hepatitis C. The number could actually be higher than reported as the data was collected based on medical 
screenings at laboratories. The undetected Hepatitis C population might be large for the simple reason that the 
disease is not manifested by any symptoms.
According to Dr Dinesh Kini, consultant gastroenterologist of Manipal Hospital, Bangalore, "Hepatitis C has a 
tendency to develop into long term liver disease and can cause liver cirrhosis and even cancer of the liver. The 
infection involves an initial phase of infection, which is often asymptomatic and lasts up to six months".
In a majority of patients (up to 85 per cent cases), the virus successfully fights the body immune system. The patients 
develop long term or chronic infection. They are now ready to transmit the disease to healthy people.
Like the HIV, the Hepatitis C virus remains in the infected patients for years together undetected. But unlike HIV, it 
does not invade the immune system but replicates successfully using the liver's resource cells.
Many times the patient does not know that he is carrying the virus except for some troubles like fatigue and 
discomfort in the upper abdominal area. It remains undetected for as long as 10 years and this is the main reason why 
scientists have so far failed in their attempts to develop a vaccine for this virus.
The WHO report on Epidemic and Pandemic Alert and Response refers to Hepatitis C virus as "highly 
heterogeneous". Eleven Hepatitis C virus genotypes with several distinct subtypes have been identified throughout 
the world.
The only good thing about Hepatitis C is that the virus does not spread by air. Since the mode of transmission is 
through skin or mucous membrane, one has to be careful while using tooth brushes, nail cutters, razors, injections 
and drug and tattoo needles. Those who are sexually active with multiple partners are at high risk of contacting the 
disease.
"If untreated the liver will be damaged. The only treatment then remains is to replace the damaged liver by a new 
one. Early detection and prompt treatment can save life," observes Dr Samir R Shah, specialist in Hepatobiliary 
diseases, Jaslok Hospital and Research Centre and Breach Candy Hospital, Mumbai.
Pegylated interferon alfa-2a (40KD) is a new generation Hepatitis C therapy and it offers sustained improvement in 
liver function and suppresses the virus in more than 50 per cent of patients. Ribavirin is the other drug found 
effective against this disease.
The pegylation of the interferon slows down the body’s ability to break down the interferon molecule. The interferon 
gets absorbed more slowly in the body and over a longer period of time. Thus constant amounts of the interferon are 
present in the body and because of this, the virus is under constant attack.
The WHO report, however, notes that "The diversities in the genotype of the virus have distinct consequences. 
Although different strains have not been shown to differ dramatically in their virulence or pathogenicity, different 
genotypes vary in their responsiveness to interferon/ribavirin combination therapy. Moreover, such heterogeneity 
hinders the development of vaccines, since vaccine antigens from multiple serotypes will probably be necessary for 
global protection".
About half of the Hepatitis C cases do not have any symptoms of the disease even though the virus is fairly active in 
the body. While 20 per cent of patients recover fully the remaining develop some form of chronicity. Five per cent of 
chronic patients develop liver cell cancer and an equal number suffer from decompensated cirrhosis.

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