June 17, 2013

A killer with a silent step

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Dr Teerha Piratvisuth
Special to The Nation June 18, 2013 1:00 am

An infectious disease affecting the liver, Hepatitis C is primarily spread by blood-to-blood contact associated with intravenous drug use, poorly sterilised medical equipment and transfusions.

Current figures for Thailand put the number of infected individuals at more than one million but most experts estimate that this is on the low side, as the disease is asymptomatic, so those infected are only likely to consult a doctor if they fall ill with another condition.

Research has also snown that the virus appears to have a geographical bias with both the north and northeast reporting a three to six per cent infection rate compared to just one to two per cent in the central region.

Hepatitis C causes chronic liver inflammation and continually destroys the liver cells, causing liver fibrosis and eventually leading to cirrhosis. This causes the liver to function abnormally, an increase in the AST and ALT levels and a gradual deterioration in the liver function, leading to chronic liver failure. While patients will have no symptoms until late in the disease, at this stage they will develop signs of jaundice, yellow eyes, ascites (build-up of fluid in the abdominal cavity) and neurological conditions as result of kidney failure. The virus can also cause liver cancer especially among patients already suffering from cirrhosis.

About 70 to 85 per cent of Hepatitis C cases can be treated through a combination of pegylated interferon injections, which are administered once a week along with oral Ribavirin.

Duration and success of the medication depends on the strain of the hepatitis C virus. Patients infected with strains 2 and 3 of the virus require 24 weeks of treatment and the chances of being cured are 80 to 85 per cent. Those infected with virus strain 1 require 48 weeks of treatment and the chance of being cured stands at 70 per cent. Patients infected with virus strain 6 require 24-48 weeks of treatment and the cure rate is 70 to 76 per cent

Two anti-retrovirals, Boceprevir and Telaprevir, were approved by the USFDA in 2011 as oral medications for strain 1 of the virus and have proved particularly useful in increasing the efficiency of the pegylated interferon injection with Ribavirin, especially in patients who have not responded well to the current treatment option. Research is being undertaken on several other anti-retroviral drugs that can used for other strains of the virus and it is hoped that before long, treatment will involve only oral anti-retroviral medications rather than the combination of oral and injected.

This will make the treatment more convenient, create fewer side effects, avoid the use of injections and increase the chances of recovery.

But to treat patients, first they must be diagnosed and for that reason, the Liver Foundation and Liver Society of Thailand are organising a campaign to educate the public about Hepatitis C and its dangers.

Dr Teerha Piratvisuth is a specialist in liver and gastroenterology at Samitivej Sukhumvit Hospital. Call the Liver and Digestive Institute at (02) 711-8822-4 or visit "samitivej" on Facebook.

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