•Hepatitis C must be detected early to treat it effectively
•Intravenous drug abusers must come forward for treatment of the addiction as well as to check for other health complications, such as hepatitis B, C, and HIV
World Hepatitis Day Dr Mukul Rastogi, Hepatologist and Gastroenterologist, Fortis Healthcare, Noida,
28 July 2016 Noida, : When Suraj Singh (name changed to protect privacy) was brought into the hospital by a concerned relative for de-addiction treatment he never imagined he would have hepatitis C. But today, protocol demands that de-addiction clinics and facilities run tests on those who have used drugs intravenously. He was lucky that it was caught early so the infection could be treated.
Hepatitis C is a blood-borne virus that is transmitted in similar ways to hepatitis B and HIV—through infected needles. It is also transmitted through blood (in the case of transfusions) and blood products. People, who have had operations with unsterile equipment, those who have had injections at a time when disposable syringes were not the norm, even those who have been exposed to tattoos, a barber’s blade or beautician’s reused equipment during a manicure or pedicure, are all susceptible. However, drug abusers, often under the radar, may not come in to get tested, and it is this group could be ‘secret carriers’ of the deadly virus that often does not show any sign of infection until 20-30 later, when the liver is damaged. Worldwide, 150-180 million people are infected with hepatitis C, while in India, the prevalence is .8-1.5%. However, Punjab has shown a higher prevalence of upto 7%.
“Risky behavior includes drug abuse and alcoholism in several cases, putting the liver in danger. However, if young people come in early, we can test them and help them both with the de-addiction as well as with getting them tested for hepatitis C and other blood-transmitted infections. Why we want people to come in to us is because we now have effective medication for the hepatitis C virus (HCV). It is inexpensive, has few side effects, can be taken orally and is a short course, compared to what it was even a year ago. The medication is 90-95% efficacious, and the earlier HCV is treated, the better cure rates,” says Dr Mukul Rastogi, Hepatologist and Gastroenterologist, Fortis Healthcare, Noida.
Doctors know that the majority of people who show the hepatitis C virus today got the infection 20-25 years ago, before regulations for safe injection practices and blood screening were implemented. The virus is largely asymptomatic, which means it may show no signs of infection. “In about 15% of people it will simply pass through the body, with signs similar to a seasonal virus. This is the spontaneous resolution of an acute infection. However, in 85% it will become chronic, remaining in the body for years, and finally show up only when the liver is damaged. Typical symptoms at this stage are jaundice, blood in the vomit and stool, swelling in the stomach cavity. There is a progression to liver fibrosis (the beginning of liver scarring), cirrhosis (scarring), and the risk of cancer. Upto 20% of chronic cases develop cirrhosis and of these, 4% can get liver cancer,” says Dr Rastogi.
It is difficult for doctors to treat to treat this group of people, as mostly, the only option is a liver transplant. In fact, hepatitis C is the biggest cause for liver transplants in India—20-30% cases are because of this, says Dr Rastogi. “We must screen people who are younger, who are at risk, so that we can contain the spread of the virus. Injection practices in urban areas are fairly safe, but a change needs to come about in rural areas, with a number of quacks practicing medicine. Also, people should get themselves tested before they decide to have a baby, as the vertical risk of transmission is 5-10%. Those who receive hemo-dialysis should preferably carry their own kit, as they do not get the infection or infect others if they already have HCV,” says Dr Rastogi.
The message is clear: every single person is at risk, but IV drug users must come forward to get tested to prevent the spread of the infection in the young.