Managing Hepatitis C virus

Rotimi Adesanya

I concluded the series on Hepatitis diagnosis and management, two months ago. I really appreciate the numerous readers of the column for all the feedbacks, comments and remarks.

I also express regrets that there were some readers whose emails and enquiries I’ve not been able to give adequate and concise responses to. But in all, I have offered useful suggestions to those who need to see experts in the field of gastroenterology/hepatology in the teaching and specialist hospitals.

This is a reader’s response to previous articles and it will

be used to support the topic of today.

“I was infected with Hepatitis C strain 1 virus in the U.S. and never knew my liver was infected until I got to New Zealand, where mandatory test revealed I was infected.

“As God would have it, my student insurance paid for a brutal year-long treatment. The symptoms are too frightening to be disclosed, but I will try. Daily and severe pains in the joint muscles and body, similar to that being experienced by someone who has been hit by a truck; anger, serious flu, loss of weight, three hours of severe daily itching, tiredness, weakness and depression were part of the deal.

“Listening to root reggae music and my faith in Christ helped prevent depression, but the severe pain continued for 18 months, to the point that I thought I had cancer. At last, the post-treatment viral load revealed the virus was cleared from my system.

“Tell Nigerians that although Hepatitis C virus is treatable, the strain called Hepatitis C strain 1 is harder to treat and for black people in the U.S., recovery rate is very low and only 50 per cent of patients get the virus cleared from their system generally. This is because many do not go for screening. As such, it has killed many.

“Thanks for this article, entitled ‘Hepatitis C kills more than HIV/AIDS.’ And note that all our barber shops are transmission points for this virus.”

Acute Hepatitis C Virus

Acute Hepatitis C Virus (HCV) is often subclinical and may not be detected since there may not be a presentation to a health care setting. Symptoms may include nausea, vomiting, anorexia and lethargy and signs may include jaundice and tender hepatomegaly (the condition of having an enlarged liver).

After an acute infection, follow up for at least six months will show whether viral clearance occurs or chronic infection is established.

About 20 per cent of adults with acute HCV infection spontaneously clear the virus within six months, but may remain anti-HCV antibody positive over a variable duration.

Eighty percent of people who become infected with chronic HCV develop chronic infection.  Most will develop liver failure and few may develop liver cancer and liver cirrhosis.

The groups at increased risk of Hepatitis C include anyone who has injected drugs, received blood products, had a tattoo or skin piercing, been incarcerated, had multiple sex partners or practised sex in a way which increased the likelihood of blood-to-blood contact or was born to a mother with Hepatitis C. Again, patients undergoing dialysis are susceptible.

Tests in Hepatitis C Virus

The basic tests used to establish the diagnosis and assess liver health are anti-HCV antibody (denoting exposure to Hepatitis C);

HCV RNA — establishes the presence of the virus and can determine viral load

Liver function tests — a raised Alanine transaminase (ALT) reflects liver inflammation and a low albumin reflects poor synthetic function of the liver. The ALT is an enzyme found in the highest amounts in the liver. Injury to the liver results in release of the substance into the blood.

Treatment

The aims of antiviral therapy in chronic viral hepatitis are to: achieve viral eradication; prevent or delay the development of cirrhosis, liver failure and liver cancer; improve quality of life; and improve survival.

The current gold standard for treatment of Hepatitis C infection is combination therapy with pegylated interferon and ribavirin. The earlier that treatment is offered, the greater the chance of eradication without the long-term complications of liver disease.

In some West African francophone countries, a drug called Hepantivir is presently used as complementary drug, in conjunction with the antiviral drugs for treatment of all forms of hepatitis. Medications are also given to support and protect the liver to prevent stress on the organ, thereby reducing the inflammation.

There is no vaccine for Hepatitis C; rather, the patients are vaccinated against Hepatitis A and B, to prevent the liver from exposure to these agents.

There may be patients with Hepatitis C who are not interested in undergoing currently available pharmaceutical treatments. This could be because of a concern about the levels of toxicity, or significant side effects. In such cases, physicians can acknowledge their patient’s choices and provide up-to-date information and advice on Hepatitis C and promote their general health.