Hepatitis C: counting the cost

But while the newest therapies represent an invaluable opportunity to fight the disease, which affects around 180 million people worldwide and kills 350,000 every year, their cost means that for all but the better-heeled or well-insured patients, the treatment remains out of reach. 

Hepatitis C is a contagious liver disease and is contracted through exposure to the blood of an infected person. There are several strains of the hepatitis C virus (HCV) genotypes that are found in different areas of the world. 

Most infected people do not experience any initial symptoms and remain unaware of the illness until liver damage occurs. Some patients develop an early and acute hepatitis C syndrome one to six months after infection. Typical symptoms include nausea, vomiting, abdominal pain, intense fatigue, fever, multiple muscle and joint pains and jaundice, the yellowing of the skin. About 20 per cent of infected individuals spontaneously clear the virus and do not develop chronic manifestations. 

The remaining 80 per cent suffer from severe and lifelong liver inflammation which, if left untreated, leads to various life-threatening complications: cirrhosis or irreversible liver scarring for up to 20 per cent of the cases and liver cancer for up to five per cent. 

In Thailand, the relatively high prevalence of hepatitis C markedly contributes to the very high frequency of liver cancer – it is currently the number one cancer among men. In the USA, the disease is the main cause of liver transplantation. 

As hepatitis C is a blood-born illness, the main people at risk today are intravenous drug users who often share needles. Hepatitis C represents an occupational risk (needle stick injury) for healthcare professionals and an infected pregnant women may transmit the virus to her baby. Hepatitis C virus is occasionally but rarely transmitted during sexual contacts as well as through unhygienic tattooing or piercing procedures or when sharing a razor or toothbrush inadvertently tainted with contaminated blood. 

Before 1992 when Hepatitis C screening was not available, patients who received frequent blood transfusions such as those afflicted by blood disorders were also often contaminated. 

The virus is not spread through food or water or through coughing, hugging or kissing.

Due to the prolonged silent period, Hepatitis C is often diagnosed during routine blood checks that reveal elevated liver enzymes. The presence of antibodies against the virus (a positive anti HCV test) confirms the diagnosis. Viral load (the quantity of virus circulating in the bloodstream), the virus genotype and the liver functions tests are performed prior to the treatment. 

Nowadays treatment protocols evolve quickly and people with hepatitis C thus should be treated by physicians specialised in liver disease or infectious disease. As a priority, the patient should avoid any liver toxic substances, which include alcohol, numerous medicines and supplements. Vaccination against hepatitis A and B may be recommended. 

The latest guidelines released in March 2014 by the American Association for the Study of Liver Diseases have highlighted the potency of the tritherapy combining the newer direct-acting antivirals (boceprevir or telaprevir) with the previous dual medication regimen. Depending on patient’s medical background, the treatment is given from 24 to up to 48 weeks, which often leads to a complete and sustained elimination of the virus. 

As there is no vaccine available at the moment, prevention relies on total avoidance of IV drugs, and being careful in attempting tattoo or piercing. Intravenous drugs users must strictly adhere to single use of injecting needles and practise protected sex.

And just as it has been with HIV infection, controlling the disease will require a strong commitment from health authorities in providing affordable medicines to all infected individuals.

 

 

Dr Gerard Lalande is managing director of CEO-Health, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at [email protected].