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.
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