Tuesday, April 14, 2015

Hepatitis-C: what you need to know & treatment options

Hepatitis C virus seeks the liver as the primary target for its multiplication and growth.  It is a RNA virus belonging to Falviviridae family.  It has a core and two distinct envelopes, which are the targets for diagnosis and various therapies.  Nearly 3% of the world population (170 million people) is affected by this virus. It is primarily transmitted from one person to another through blood to blood contact. Exposure to the virus happens in Hospitals, clinical laboratories, hair saloons, Temples where head tonsuring is done, Health spas, Dentists and Tatoo centers.  The infectivity is most when a dose of infected blood is delivered through a hollow needle puncture or blood transfusion.  70-80% of those who get infected with hepatitis-C will develop chronic liver infection.  Of these 20% would go on to develop liver cirrhosis within 20 year period.

The hepatitis-C virus has been difficult to eradicate and treat owing to its tenacity to mutate and exist as several genotypic variants.  Since it has a defective enzyme assisting in proliferation, multiple mutations tend to occur and this allows the virus to escape immunity and any chance of developing a vaccine.  It is known to have 6 distinct genotypes with multiple subtypes a to c.  The geographic prevalence of the genotypes vary from country to country and also from state to state.  For instance the genotype-1a is most prevalent (50%) in the US as opposed to types 2 and 3 in India.  The risk of all outcomes is worse with type 3 as compared to type 2.

Most people who are infected remain as silent carriers as the disease has an indolent course.  The symptoms may surface 5 to 10 years after contracting the infection unless they suffer from an immunocompromised state.  Majority would present with nonspecific symptoms like fatigue, joint pain, itching, flu like symptoms and altered sensations in hands and feet.  In late stages presentation are due to frank liver failure- jaundice, tremors, swelling of the feet, fluid collection in the belly and weight loss.

Diagnosis of hepatitis C infection is made by a blood test with ELISA or rapid test. If this turns out positive, a detailed HCV-RNA PCR test is required to quantify the viral load and to determine the genotype of the virus. It is advisable to have a liver biopsy to document the level of damage in the liver before the treatment is started, though it is not mandatory. The conventional treatment is most developing countries till date has been to use Interferon plain or pegylated (long acting) injections along with Ribavarin 1000 to 1400 mg daily for 24 weeks to 48 weeks (the sustained viral response rate- SVR is approximately 60% across all viral subtypes).

Newer group drugs which are HCV protease or polymerase inhibitors are now approved for treatment.  The only protease inhibitor available in India is Sofosbuvir (Sovaldi, Gillead life sciences) or HEPCINAT. The dose and duration of Hepcinat as well as the correct combination of drugs depend on several patient and virus specific inputs.  The SVR for Hepcinat is more than 90% after 12 to 24 weeks treatment. It is to be used only under close monitoring and prescription from a qualified liver specialist.

www.Liverindia.com has added this unique service of evaluation of patient inputs, generation of e-prescription and delivery of HEPCINAT (Sofosbuvir), electronically for free.  You only pay for the medicine at a subsidized cost. What’s more, registered members get to have free online follow up.

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