Shahid Akhter, editor, ETHealthworld spoke to Dr. Yogesh Batra, Sr. Consultant & Director, Gastroenterology & Hepatology, BLK Hospital, New Delhi to know more about challenges associated with Hepatitis C. Edited excerpts :
About 80% of hepatitis C cases are asymptomatic, making diagnosis and treatment challenging. What do you believe can be done to address this issue and encourage early diagnosis?
Liver is a very large organ and both Hepatitis B and C viruses get into the liver and stay there and until a large portion of the liver is destroyed, liver disease does not manifest. Once it does manifest it is usually too late. So, since 80% of these diseases remain asymptomatic for a very long time, it is very difficult for these patients to be caught early and treatment would be instituted early. What needs to be done is that regular screening programs need to be done and these screening programs should be done specifically for those individuals who are at high risk. For example, those who are multi- transfused or those who have a history of drugs…
Who is at risk of a hepatitis C infection and why?
There are multiple groups who are at risk for Hepatitis C. It can spread through the skin and blood or it can spread through sexual contact. These are the two main reasons for the spread of Hepatitis B. In terms of percutaneous, that spread through the skin, those who require repeated blood transfusion that is the commonest form of spread of Hepatitis C. This happens in certain conditions like hemophilia, sickle cell, anemia where there is a deficiency of blood and they have to be transfused repeatedly. Those patients who have had road traffic accidents and have received multiple-transfusion, specifically in the scenario when these transfusions were not screened properly, drug addicts and people who needles repeatedly for injection of these drugs, healthcare workers who are not careful and can acquire pricks from patients who were infected and then the same needle got inserted into the worker themselves… Those who are infected with HIV are also prone to develop HCV infection.
Your observation on recent trends in Hepatitis C ?
In India there is a huge explosion of Hepatitis C. There are certain states which have seen a very great rise in the incidence of Hepatitis C and these states are Punjab, Haryana and parts of Uttar Pradesh, specifically western Uttar Pradesh. They do not know the exact reason for this but there are villages in these regions in which almost 80% of the population is suffering from Hepatitis C. So as one comes down from Kashmir, Hepatitis C starts appearing and almost till Delhi it is prevalent from where it turns gradually into Hepatitis B. These pockets of Hepatitis C have been researched very extensively but no cause has actually been found so far as to why this is happening. Punjab as a state has witnessed a great rise in the incidence of Hepatitis C, so has Haryana. There are regions in western U.P were entire village are suffering from Hepatitis C. We are also seeing hepatitis C epidemics. So Hepatitis C which was supposed to be a very quite kind of a virus is suddenly started appearing in epidemic forms where a large populations of entire villages are coming up with jaundice and symptoms of Hepatitis C.
Hepatitis C is India’s hidden epidemic. What is the reason for this high mortality and how can India address the situation?
Almost 85% of those who have acute hepatitis, secondary to hepatitis C go on to develop chronic hepatitis. Those who develop chronic hepatitis, subsequently develop cirrhosis which has effect on the brain and bleeding or jaundice and then end up requiring a transplant or they develop a liver cancer. So these are the stages. In this stage, we can intervene till the stage of chronic hepatitis. Till the chronic hepatitis sets in, you can actually give medication and treat and cure the virus completely. If you wait till the chronic hepatitis has turned into cirrhosis then nothing can be done. So if the virus has to be treated it has to be treated early before chronic hepatitis sets in. Hence, once again that screening is a part of management of hepatitis C. There are two large groups in India which are actually being screened: one is pregnant women, so almost every pregnant woman is now undergoing screening for all 3 viruses Hepatitis B, C and HIV. Second group is those who donate blood for transfusions. These are patients who are being picked up in routine screening to know the status and then they can be managed. However, possibly, population based screening is now becoming relevant and we should be thinking in terms of that because now it is very easy to treat the virus with the advent of oral drugs. Hence, anybody who has a suspicion or is at risk for developing Hepatitis C should definitely be screened for Hepatitis C. Even those who do not have a risk, should probably be screened for Hepatitis C specifically those who are undergoing annual health checks or applying for a new job.
Your message for World Hepatitis Day
My message for World Hepatitis Day would be that do not be scared of hepatitis B and hepatitis C. Both viruses are completely treatable, get screened and get treated early.