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HEPATITIS C, A SILENT KILLER



Most people will be familiar with the viruses that cause hepatitis A and B and the detrimental effects these diseases can have on the liver.

Fewer are aware, however, of the Hepatitis C virus (HCV), which has been around for many years but, until 1989, was known as "Non A, Non B Hepatitis. Between 1 and 2 per cent of the Thai population is now known to be infected with chronic Hepatitis C, meaning that roughly one million Thais have contracted the disease.

Epidemiological studies conducted in Europe, America and Asia indicate that Hepatitis C patients have a higher risk of getting liver cancer. About 20 to 25 per cent of patients develop cirrhosis within 20 years and between 3 and 5 per cent of those cirrhosis patients go on to develop liver cancer.

HCV is spread primarily by blood-to-blood contact and is mainly associated with intravenous drug use, transfusions and poorly sterilised medical equipment and here in Asia, tattooing and body piercing as well as acupuncture. Sharing razor blades with an infected individual can also cause contamination but transmission through sexual activity or from mother to baby is very rare and highly unlikely.

An asymptomatic disease, HCV is usually detected by chance during a general health check-up or a blood test prior to blood donation. Testing will reveal unusually high liver enzymes, indicating possible infection and liver inflammation.

There are a number of diagnostic tests for hepatitis C, among them the HCV antibody enzyme immunoassay, which tests for immunity, and the quantitative HCV RNA polymerase chain reaction.

As treatment is often very expensive, the doctor will make an assessment of the level of inflammation and the stage of the illness to determine if treatment is necessary and for how long medication should be given. A biopsy can be performed, with the tissue sample analysed to identify the prognosis of the illness, the cause of the hepatitis and as well as other underlying liver diseases.

In more severe cases, an ultrasound or computerised tomography can be carried out in conjunction with a blood test for alphafeto protein to detect liver cirrhosis or growth in the liver.

The progress of the disease varies significantly. In some individuals it may be decades before it develops into cirrhosis. In others the elapsed time may be as short as five years. The doctor will assess and evaluate a chronic hepatitis patient to determine the appropriate treatment. Currently the disease is treated with Peginterferon-alpha-2b or Peginterferon-alfa-2a injections in combination with Ribavirin, taken orally every day for 24 to 48 weeks. The treatment has an average 60 per cent success rate depending on viral genotype, resulting in a decrease in inflammation and the absence of Hepatitis C virus after the treatment has been stopped for at least 24 weeks. Most patients do not experience a recurrence of the disease if the virus is not present 24 weeks after the treatment.

Treatment using a new type of Interferon has also become available and is more convenient, since it can be retained in the body much longer. It's administered by weekly injection. New oral medications are also being introduced.

With no vaccine yet developed to protect against Hepatitis C, it's important that

people take simple steps to avoid being at risk:

  • Avoid taking drugs by injection.
  • Avoid sharing sharp cutting instruments with other people.
  • Avoid receiving blood or blood products that have not been screened for Hepatitis C virus.
  • If you've been receiving transfusions for more than 10 years or suspect you might have an abnormal liver function, seek an assessment from your doctor.
Couples can lead normal lives but should refrain from sexual activity during the wife's menstrual period and any activities that might easily lead to skin abrasions. Female patients can have babies and breastfeed them as normal. The chance of a baby contracting the disease is minimal.

Dr Pitulak Aswakul is a gastroenterologist with the Liver and Digestive Institute of Samitivej Sukhumvit Hospital. Call (02) 711 8822-4.


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