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Finally, a remedy for killer virus
After years of hard work and painstaking research, it is now possible to eradicate Hepatitis C virus (HCV) in almost 100 per cent of patients with advent of new drugs, called Directly Acting Antivirals or DAAs. For the very first time, an all-oral regime of DAAs' minus an Interferon injection can successfully eradicate HCV. Globally over 170 million people are infected with HCV, out of which approximately 100 million are in SE Asia and the Western Pacific region. India has almost 3-4 times the number of HCV positive patients as compared to USA (13-14 million versus 4 million). Globally, Hepatitis C is second to Hepatitis B in causing liver cirrhosis and/ or liver cancer. About 20 per cent of HCV-infected patients will develop liver cirrhosis over 20 years. Clinical diagnosis of liver cirrhosis and/or liver cancer is generally delayed or missed at early stages. HCV is more prevalent than HIV and causes greater mortality than HIV. Despite this fact, HIV has globally got more attention and funding . HCV has six genotypes, while genotype 1 is more prevalent in the west and is the most difficult to eradicate. Genotype 3 is more prevalent in India. Modes of spread HCV spreads always by percutaneous exposure (skin or mucosa has to be breached). This occurs by sharing contaminated needles and syringes, by receiving untested blood or blood products, haemodialysis, unsafe sex practices, tattooing, acupuncture, sharing of shaving kits or visit to a roadside barber. Certain kind people are most likely to spread the HCV virus - prison inmates, and intravenous drug users (IVDU). Less commonly it may be transferred from mother to baby. HCV does not spread by oro-feacal route or by sharing food articles Current treatment Weekly injections of Peglated Interferon and daily oral Ribavirin for 6 months to 12 months is the current standard of care. Response rate to this regimen is up to 70 per cent with frequent side-effects like fever, lowering of platelets, anaemia, depression etc. Many patients are unable to continue the therapy because of severe side effects. In May 2011, US FDA approved the first new therapy for HCV, called Directly Acting Antivirals (DAAs'). These were Boceprevir and Telapevir which increased the response rate substantially when used in combination with injection of Peglated interferon and oral Ribavirin. These new drugs are costly, have a significant pill burden per day and have to be taken three times a day and have significant drug to drug interaction and side-effects. These drugs are still not available in India. Breakthrough therapy Such is the impact of these new drugs on eradication of hepatitis C virus, that they have been categorised under the FDA's new "breakthrough therapy" drugs. However, these drugs will be costly and their success in end stage liver disease is yet to be established. The real challenge of HCV therapy is to have effective outreach programs so as to actually reach and treat all patients. At present even in USA less than 5 per cent of HCV infected patients receive proper treatment. To have more effective health education regarding HCV including continued medical education (CME) programs, to involve global health agencies like WHO, to involve local government and nodal agencies, to subsidise HCV therapy and testing are some of the ways to help us to achieve HCV-free world. Benefits of HCV eradication This translates into lower risk of liver-related deaths, due to liver cirrhosis and/ or liver cancer. Patients have a better quality of life, have less fatigue and better neuro-cognitive functions. It must be mentioned, that the patients who clear their hepatitis C virus, must still be followed up long-term as the risk of developing liver cancer, although decreased, is still significant, especially in patients with liver cirrhosis. — The writer is Director Gastroenterology, Fortis Hospital Mohali
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Globally 170 million
people are affected with HCV
