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| HEALTH & FITNESS |
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Uric acid: Life-style connection
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The silent killer — hepatitis C Hepatitis C infects 3% of the world population. It can strike anyone, anywhere and anytime. Hepatitis C, along with Hepatitis B and alcohol ranks in the top three global causes of liver cirrhosis, liver failure and liver cancer.
What is Hepatitis C?
Hepatitis C virus was first discovered in 1989. It has 6 genotypes, genotype 1 being the most prevalent in the USA and Europe. India has predominantly genotype-3.
Epidemiology
Globally 180 million people are chronically infected with Hepatitis C virus: China has 40-42 million, India 13-14 million, Europe 10 million, US 3-4 million and Japan 2 million. Globally, 3 to 4 million new cases of Hepatitis C occur annually, with the annual mortality of over 350,000. India has an HCV antibody prevalence rate of 1.25-1.8%, which falls in the intermediate endemicity for HCV.
Routes of transmission
It spreads by transfusing infected blood and blood products, and use of contaminated needles or syringes, etc, and shares the same mode of transmission as Hepatitis B virus and HIV. Hepatitis C does not spread through the oral-faecal route or by sharing food items with the infected persons. Blood and blood products tested by ELISA test, though sensitive, detects the HCV antibodies after a gap of 50-60 days, the so-called Window Period, in which HCV infection may be transmitted to the recipient. NAT (nucleic acid test) which is used in the West is highly sensitive but very costly.
Whom to screen for Hepatitis C?
Acute and chronic HCV infection
Once Hepatitis C virus enters the body, in 70-80 % of the times it becomes chronic and persists for decades. A majority of the patients with an acute or chronic HCV infection are asymptomatic. Fatigue is a prominent symptom in chronic HCV infection. Some of the late manifestations include jaundice, vomiting of blood, swelling of the feet, abdominal distention and drowsiness. Approximately 20% of these chronically infected patients will develop liver cirrhosis within 20-25 years, out of which 5% patients will develop liver failure and/or liver cancer every year.
HCV and liver cancer
The risk of liver cancer increases by 17 folds if a person has HCV-related liver cirrhosis, and is seen maximum in elderly male patients, especially with HIV or Hepatitis B co-infection. HCV is the commonest cause of liver cancer in the USA, Italy and Japan whereas Hepatitis B-related liver cancer is mostly seen in Africa and in most of the Asian countries.
HCV and alcohol
An absolute no-no. Alcohol in Hepatitis C patients can cause liver cirrhosis at a much younger age. The risk of liver cirrhosis is increased 10 times with this combination. Prolonged heavy drinkers are particularly at risk.
HCV and HIV
A really bad co-infection. Up to 30% of HIV positive patients may test positive for HCV. HCV liver disease is aggressive in this group of co-infected patients. In mothers who are HIV positive up to 20% may transmit HCV virus to the baby.
HCV and liver transplantation
HCV remains the commonest indication for liver transplantation in the USA and Europe. Survival of HCV positive patients is slightly lower than HCV negative patients. This is because of near universal recurrence of HCV after liver transplant leading to cirrhosis and graft failure in about 1/3rd of all cases.
HCV — worsening statistics
In the next one-two decades the mortality related to HCV virus is likely to increase three- folds and the number of patients needing liver transplant is likely to increase by five folds. Cost issues are likely to escalate to over two folds.
Treatment of HCV
Hepatitis C can be cured especially in the early stages. The standard of care includes weekly injections of pegylated interferon and daily tablets of Ribavirin which is used for six months in genotype 3 infection and up to one year in genotype 1 infection. This treatment gives a response rate of 70-75 % in genotype 3 and 40-50% in genotype 1. Treatment is costly, prolonged and has side-effects which may lead to discontinuation of treatment in some cases. The patient’s adherence to treatment is of utmost importance during therapy. Women have a slightly better response to therapy. However, the real test in HCV treatment is that the virus should remain undetectable in the blood even after six months of stopping therapy. This final response is known as SVR (Sustained Virologic Response) which translates into clinical cure.
What is new in HCV therapy?
Plenty! Almost 30 new drugs are in various stages of development against Hepatitis C virus. Out of these, two drugs, Telaprevir and Boceprevir, are already in use; both drugs are active against Genotype 1. These drugs are used in a combination with standard treatment. The response to these drugs to HCV infection has increased by 20-25%. These drugs are costly and have many drug-drug interactions.
Hepatitis C vaccine — preventive and therapeutic
It may be a reality in next 4-5 years! Recombinant vaccine vectors made of HCV proteins are delivered by adenovirus (The same virus which causes common cold), and good and sustained antibody response is seen. A therapeutic vaccine of HCV has already been tested in phase II in human trials in Europe with good results. This vaccine is given in 4-6 doses during standard treatment of HCV infections, and has shown almost 20% better virological response. One of the important indications of this vaccine use could be in hepatitis C-related post-liver transplant patients in an effort to decrease the allograft re-infection with HCV virus.
Do’s and don’ts for HCV- positive patients Don’ts
Do’s
Take home messages
The writer is Director — Gastroenterology, Fortis Hospital, Mohali |
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Uric acid: Life-style connection Uric acid is the outcome of a normal metabolic process of the body. During the usual physiological course, a certain type of natural substance called purine, which is present in all body cells and also to some extent in all foods, gets changed into uric acid. Since it serves as an anti-oxidant and helps prevent damage to our blood vessel lining, uric acid is an essential constituent of our physical build-up. It is only when its concentration becomes high in the body leading to certain health problems like gouty arthritis and urinary stones, uric acid becomes a treatable disease. Since ancient times, the rise in uric acid has been attributed to faulty lifestyle, a consistently wrong diet and also to an extent the genetic predisposition of a particular individual. Modern-day health scientists conclusively believe that improper metabolism of purine whether dietary or originating in the process of normal physiological wear or tear is the basic reason for the high uric acid in the body. The Sanskrit term ‘vata rakta’ used for the high concentration of uric acid aptly tells its metabolic origin. People who are either easy going, obese, given to sedentary lifestyle or careless about their diet and proper daily schedule are more prone to get gout in their life. When we talk about a faulty diet in relation to uric acid, nothing can be better elucidated than what the classic ayurvedic literature has explained about it. It says that the excessive intake of food articles which are acidic, bitter and salty in taste and hot and unctuous in nature add up in their effect raising the uric acid. A high intake of non-vegetarian food, specially red meat and poultry items and sometime excessive use of even vegetarian diet of lentils, peas and beans and indiscreet usage of eatables which are not compatible with each other, are also the reasons for the uric acid build-up in the body. Alcohol and its accompanied diet, which most of the times is rich in protein, additionally contribute to raising uric acid levels and that is why ayurvedic masters have described gout as “adhya vata”, meaning a disease occurring among the affluent sections of society. Parts of North India specially Punjab and Haryana are nowadays called the uric acid belt, thanks to the protein-rich diet and increasing alcohol consumption in the area. Some unexplained changes in the ground water chemistry in the region have also been thought to be the reason for the rising incidence of gout and urinary stones in this belt. Though it is not uncommon in women to get the level of uric acid raised around menopause, men tend to be more susceptible to its high concentration at an earlier age. People who as a habit take less water but consume heavy and high protein diet and do not exercise are more likely to get their uric acid levels raised. It is generally seen that symptoms and manifestations of high uric acid are more pronounced in men than women. Since the precipitating factor of an attack is always a wrong diet, it becomes important for a person suffering from gout to have a look at his lifestyle and food habits and adopt a disciplined approach. In the long run it is the self-care which proves to be far more helping than any other medication. The foremost tip to follow the uric acid lowering diet is to restrain the intake of non-vegetarian food, especially red meat, fish and eggs. It is a proven fact that plant-based proteins are more body-friendly and are better metabolised. Though excessive consumption of tea or coffee causes hyperacidity which has been also mentioned as a prelude to many of the health problems, including the rise of uric acid, alcohol definitely interferes with the natural excretion of uric acid. The accompanied diet of alcohol which is usually fried, heavy and effectually rich in protein is infamous to cause uric acid build-up. On the vegetarian side, taking low fat milk products and minimising the use of cheese help reduce high uric acid. Vegetables with an exception of mushroom, brinjal , spinach, peas and dried beans and cereals such as brown rice and whole wheat ‘atta’ are on the recommended list. Lentils are generally high in purine contents and these can be taken only in polished form, and similarly red beans and black grams also do not find a place in the uric acid lowering diet plan. Ayurveda generally prohibits the consumption of curd in dinner and it is only its stirred and diluted form (raita) mixed with some vegetables like cucumber or boiled bottle guard (ghia) can be taken by patients of high uric acid. Adequate water intake activates the kidneys to excrete and eliminate uric acid. During the summer months and rainy and humid conditions one should be careful to consume sufficient quantity of liquids. The writer is a Ludhiana-based senior ayurvedic physician and Guru at the Rashtriya Ayurveda Vidyapeeth. E mail- ayu@live.in |
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Orange juice can make you look more beautiful
London: A daily glass of orange juice can help improve your skin, hair and nails, say a panel of health and beauty experts.They attribute the benefits to vitamin C, potassium and folic acid it contains. Vitamin C is essential in the production of collagen, along with super nutrient Lutein.Its yellow pigment is linked to reducing sun-induced skin damage and is believed to improve elasticity of the skin.A 200 ml glass of orange typically contains 60 mg vitamin C and equates to 100 per cent of an adult’s recommended daily amount. “The adage of ‘you are what you eat’ is not a new one but science has lagged behind in determining the effect nutrition has on our skin, hair and nails,” The Mirror quoted nutritionist Amanda Ursell as saying. — ANI
HIV-infected patients taking ART fail to keep disease in check
Washington: HIV-infected young adults, blacks, injection drug users and those who lack health insurance are less likely to have the disease under control while taking antiretroviral drugs, according to results of a study by AIDS experts at Johns Hopkins and the University of Pennsylvania. The study also pointed out that tens of thousands of Americans taking potent antiretroviral therapies, or ART, to keep their HIV disease in check may not have as much control over the viral infection as previous estimates have suggested. In what is believed to be the largest and longest review of viral load test results in people with HIV disease ever performed in the United States, researchers found that the number of people sustaining viral suppression — consistently, at 400 or less viral copies per millilitre of blood, year after year — is roughly 10 per cent less than previous estimates. — ANI
Drug-resistant HIV on rise in sub-Saharan Africa
London: Experts including an Indian origin scientist have warned that drug-resistant HIV has been increasing in parts of sub-Saharan Africa over the last decade. The team, which reviewed studies on 26,000 untreated HIV-positive people in developing countries, said resistance could build up if people fail to stick to drug regimes, and because monitoring could be poor. The researchers, from the World Health Organisation (WHO) and University College London (UCL), found the most rapid increase in drug resistance occurred in East Africa, at 29 per cent per year. In Southern Africa, it was 14 per cent per year. There was no change in resistance over time in Latin America and in West and Central Africa. — ANI
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