“I don´t know why Hepatitis C is neglected? May be it is due to the fact that screening is done for Hepatitis B while going abroad and not for C,” says hepatologist (liver specialist) at Bir Hospital Dr Sudhanshu KC. [break]
Dr KC says Hepatitis C is more of a threat because of its asymptomatic nature which makes it difficult to diagnose in absence of screening. “While 25 percent of Hepatitis B cases show symptoms, in Hepatitis C the symptoms can be seen only when the disease becomes severe,” Dr KC explains.
The disease is further dangerous in that there is no vaccine for its prevention unlike Hepatitis B. The lack of vaccine also makes doctors and medics susceptible to the disease and Dr KC concedes even he regularly does screening for the Hepatitis C Virus (HCV).
He says chance of chronicity (becoming chronic) is also very high in Hepatitis C. “While the body can flush out Hepatitis B in 90 percent cases, there is 80 percent chance of the disease becoming chronic in Hepatitis C cases,” he adds.
There are generally four consequences of contracting HCV. In the first case the body completely flushes out the virus in time, while in the second case HCV is not seen in blood even though the anti HCV test (test for antibodies against HCV) returns positive.
In the third anti HCV test is positive and HCV is also seen in blood while in the fourth HCV is seen in blood despite the anti HCV test returning negative. “There is no need to treat the first two types of cases but the latter two should be treated,” Dr KC states.
Dr KC says there has not been much research on the disease in Nepal but a few sporadic data shows that it is prevalent in around 0.6-0.7 percent of healthy persons. Its prevalence is very high in injectable drug users. “Almost 95 percent of such drug users have Hepatitis C,” he confirms.
Going by the calculation, there are around 20,000 seemingly healthy persons (0.6-0.7 percent of around 3 million) with HCV in Kathmandu Valley alone apart from another 25,000 intravenous drug users.
The disease can be transmitted through injectable drug users, blood transfusion, medical practitioners dealing with the disease, tattooing and spouses, though there are not any clinical cases of sexual transmission in Nepal, according to Dr KC.
“Out of around 60 severe Hepatitis C cases that I have treated, five were contracted through tattooing,” Dr KC says and warns to take precaution while making tattoos.
If untreated, chronic infection of HCV can progress to fibrosis (scarring of the liver), and cirrhosis (advanced scarring) in about 15-20 years. “But it can lead to cirrhosis in less than five years in case of alcohol abuse,” Dr KC warns.
Cirrhosis can lead to liver failure or other complications including liver cancer. “Treatment of Hepatitis C can be done even in the early stage of cirrhosis with very high success rate, but it is very expensive in comparison to Hepatitis B,” Dr KC reveals.
The cirrhosis induced by 2 and 3 genotypes of HCV, the most common types in Nepal, can be treated in six months at an expense of around Rs 500,000 in Nepal while that of 1 and 4 require a year and consequently around Rs 1 million.
Dr KC claims that the standard of treatment of these Hepatitis C cases in Nepal is up to the level in India and much cheaper. “I have a few cases where Indian hospitals have referred their patients back here,” he reveals.
premdhakal@myrepublica.com
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