Islamabad
Hepatitis C virus (HCV) infection that is associated with a greatly increased risk of liver cirrhosis (scarring of liver) and liver cancer is one of the most important health issues throughout the world including Pakistan where well over eight million people are living with the disease.
According to one estimate, 130-170 million people are infected with HCV worldwide while approximately 700000 people die each year from hepatitis C-related liver diseases. South Asia has moderate prevalence (1.5%-3.5%) of hepatitis C. According to World Health Organization (WHO), about 8 million people are exposed to hepatitis C virus in Pakistan.
Hepatitis C virus (HCV) that was first discovered in 1987 by Dr. Michael Houghton has been classified into eleven genotypes. Out of these eleven, six are the major genotypes which are further classified into many subtypes. Genotype 3a is the commonest genotype of HCV infections in Pakistan.
Consultant Physician at a private hospital in the federal capital Dr. Azmat Ali expressed this while talking to ‘The News’ in connection with World Hepatitis Day that is observed on July 28 around the globe.
While today’s problem and burden of disease is hepatitis C, nevertheless hepatitis B also merits mention, he said. It can present both as acute and chronic hepatitis. Acute infection generally behaves like other hepatic infections needing supporting care. Chronic infection; once it occurs has specialized drugs like Entacavir etc. available as oral pills. Treatment is prolonged. Vaccine available against hepatitis B and public inclination towards its use has reduced hepatitis B infection in the past 10 to 20 years, said Dr. Azmat.
Hepatitis is a disease of liver characterized by abnormalities in the liver leading to its failure. Liver is one of the main organ of the body responsible for numerous functions. It acts as a part of digestive system and helps digest food especially fat. It detoxifies waste products produced in the body and processes different drugs and hormones. It is responsible for production of useful materials and is a storage site for certain vitamins (A, D, E, K and B12) and minerals (Iron and copper).
Dr. Azmat explains that hepatitis is commonly caused by viruses but there are other possible causes of hepatitis as well including autoimmune hepatitis, and hepatitis secondary to drugs, medication, toxins and alcohol. There are 5 main hepatitis viruses, referred to as types A, B, C, D and E. Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of contact with infected body fluids and blood, he said.
He explained that following infection with the hepatitis C virus (HCV), chronic infection typically occurs, with approximately 50 to 85 per cent of cases developing chronic hepatitis. However, chronic HCV infection is usually slowly progressive and may not result in clinically apparent liver disease in many patients. Approximately five to 30 per cent of chronically infected individuals develop cirrhosis over a period of 20 to 30 years. Estimates of the risk of developing liver cancer once cirrhosis has developed have varied from 0 to 3 per cent per year in various reports, he said.
He added that internationally, major risk factors for transmission of this virus include Injection Drug Users (IDUs), blood transfusions, reuse of syringes, facial and armpit shaving by barbers and unprotected sex. In Pakistan major modes of transmissions are I/V injection/drip, nail cutter sharing, shaving from barbers, razor sharing, needle stick accident, dental procedures, sexual promiscuity or ear and nose piercing, said Dr. Azmat.
He added that most people with hepatitis C have no symptoms. When symptoms occur, they may include feeling tired or weak, lack of hunger, nausea, muscle or joint aches and weight loss. In most cases, hepatitis C lasts for many years. That can lead to liver scarring, called “cirrhosis”, he said.
He added that in many cases, patients with cirrhosis have no symptoms and when occur, symptoms may include swelling in the belly and legs, and fluid build-up in the lungs, bruising or bleeding easily, trouble taking in a full breath, feeling full in the belly, yellowing of the skin or whites of the eyes, called jaundice, confusion that can come on suddenly and coma.
Talking of management of hepatitis C, he said treatment of this debilitating illness has evolved over time and has reached a point where this threat has almost been made controllable. Introduction of Directly Acting Antivirals (DAAs) have revolutionized the management of Hepatitis C. DAAs are oral drugs to be taken with or after meals having no serious side effects and high rate of cure, he explained.
Dr. Azmat said availability of sofosbuvir, daclatasvir and velpatasvir (DAAs) for hepatitis C has improved response rates in hepatitis C treatment. Sofosbuvir is being marketed in Pakistan but daclatasvir and velpatasvir are still not available for use. Their low price, very well tolerability, negligible side effects and duration of treatment as low as 12 weeks in majority of cases, all by oral route will revolutionize treatment for common man, he said.
He, however, added that currently no vaccine is available for protection from hepatitis C. In order to protect liver, people should avoid alcohol, maintain healthy weight and should not use over-the-counter medications. Hepatitis C does not spread by sharing spoons, forks, cups, food, sneezing, coughing, hugging, kissing or breast feeding, said Dr. Azmat.