Hepatitis means inflammation of the liver. Hepatitis C infection (HCV) can become chronic and cause long-term illness such as liver cirrhosis and cancer.
HCV has six major genotypes, referred to as genotype 1 through 6. Genotype 1 has been found through clinical trials to be the most difficult to treat. Genotype 1 is also the most common form of HCV, accounting for about 60% of global infections and is found predominantly in Europe, North America and Japan.
It is important for the treating physician to determine which HCV genotype a patient has, as this information can influence decisions regarding the type and duration of treatment.
According to Professor Dr Rosmawati Mohamed, Consultant Hepatologist and Executive Member of the Coalition to Eradicate Viral Hepatitis in Asia Pacific (CEVHAP), HCV causes inflammation of the liver. Hepatitis C infection can become chronic and eventually lead to complications such as liver cancer and cirrhosis (liver scarring).
Approximately 170 million people worldwide are chronically infected with HCV and more than 350,000 are estimated to die each year from HCV related liver disease.
WHO IS AT RISK?
A major risk factor for HCV infection is through blood transfusion of unscreened blood or blood products.
Other risk factors are sharing of equipment when sniffing or injecting drugs among drug users, body piercing, mother-child transmission and needle-stick injury.
Although hepatitis is not easily spread through sexual intercourse, high-risk sexual behaviour such as having multiple sexual partners is associated with an increased risk of HCV infection.
Screening for HCV infection among blood donors has reduced the risk of acquiring the virus from blood products by half to two-thirds.
THE SILENT KILLER
Although Hepatitis is more prevalent than HIV or any type of cancer, it receives almost no attention from the public. This makes Hepatitis one of the world’s major health threats and certainly should not be taken lightly,” stressed Professor Dr Rosmawati.
Professor Dr Rosmawati terms HCV as a ‘silent killer’,as many are not aware of the symptoms, most of which are non-specific and can sometimes be masked as other health conditions.
“Symptoms of Hepatitis C infection include fatigue, poor concentration, nausea and abdominal distension. In the majority of cases, symptoms do not appear until the disease is advanced,” clarified Professor Dr Rosmawati. Uncommon symptoms include loss of appetite or anorexia, dark urine and jaundice (a yellowing of the skin or eyes).
Based on statistics from the World Health Organisation (WHO), 60% to 70% of Hepatitis C patients will develop chronic liver disease while 5% to 20% develop cirrhosis and eventually, 1% to 5% will die from cirrhosis or liver cancer.
In Malaysia, the prevalence of hepatitis C is about 1.5%.
SCREENING FOR HCV
Testing for HCV has been made easy by just a simple blood test. Screening for individuals at risk is important because most people who have HCV are unaware of their condition and are at risk of spreading it to others.
Screening and testing of HCV is often missed because many are not aware they have it due to the common symptoms. Therefore, normal methods of antibody detection cannot differentiate between acute and chronic infection.
Once tested positive, it is advisable to see a hepatologist (liver specialist) or a gastroenterologist for further evaluation and consultation. Thanks to modern medicine, the further evaluation of the condition are easily performed by more specific blood investigations and other tests to assess the liver condition.
Professor Dr Rosmawati also highlighted HCV risk factors such as blood transfusion before the early 1990’s, body piercing, tattooing, needle-stick injury particularly amongst healthcare workers, injecting drug users and high-risk sexual behaviours with multiple partners.
TREATMENT FOR HVC
Generally, the most common treatment has been pegylated interferon in combination with ribavirin. However, interferon is not widely available, nor is it always well tolerated while some genotypes are less responsive towards it.
The recently launched boceprevir that is used in combination with peginteferon and ribavirin, VICTRELISTM, has shown positive results, especially for treating HCV genotype 1. According to Dr Tan Soek Siam, Consultant Hepatologist who was present at the launch said, “HCV has six major genotypes – genotype 1 through 6 with genotype 1 being the most difficult to treat.In Malaysia, the two most common genotypes found are genotype 1 and genotype 3.”
VICTRELISTM is classified as a direct acting antiviral where the combination medicine attacks the virus itself, as opposed to current available treatment which only works to boost the immune system to stimulate an appropriate response to achieve a sustained virological response (SVR), which is equivalent to a cure in Hepatitis C.
The chances of eradicating HCV with the previous standard treatment for genotype 1 Hepatitis C is around 40%. With the addition of VICTRELISTM to the standard regiment, patients can expect about a two to three fold cure rate.
The World Hepatitis Day on July 28 was declared by WHO at the 63rd World Health Assembly in 2010. For more information about the Malaysian campaign on World Hepatitis Day and HCV, please log on to www.myhepatitisday.com and www.worldhepatitisalliance.org
WARNING SIGNS OF HEPATITIS C
- Loss of appetite / anorexia
- Stomach pain
- Dark urine
- Jaundice – yellowing of skin or eyes
- Nausea and vomiting
- Aching muscles and joints
- Poor concentration
- Anxiety and depression
- Joint pain