HCV epidemic lurks in Nepal

Chhatra Karki, CNS Correspondent, Nepal
In communities where sharing of injecting equipment drives the HIV epidemic, a parallel epidemic of hepatitis C virus (HCV) often lurks quietly. Though a majority of people have been found to be cautious about Hepatitis B, very few people give Hepatitis C the seriousness it warrants. But the physicians opine that risks posed by Hepatitis C are no less dangerous considering its negative effects on health.

Dr Dilip Sharma, who is with the Department of Liver at Bir Hospital, Kathmandu, Nepal, informed that a lot of people inquire about Hepatitis B, whereas those who seek information about Hepatitis C is negligible. There is a need to raise social awareness that Hepatitis C too can be detrimental to human health. He further added that the symptoms of Hepatitis C become apparent only in the last stages, making the disease even more dangerous.

Hepatitis C is a blood borne virus. So unless anyone comes in contact with blood from someone with hepatitis C there is no risk of transmission. To prevent transmission, it is advisable for people living with hepatitis C not to share anything that may have come in contact with their blood such as toothbrushes, razors, injecting needles and manicuring tools.

Physicians say Hepatitis C is a chronic disease. Dr. Sharma informs that Hepatitis C virus (HCV) develops in four stages, with the final stage often proving to be fatal.

In the first stage, there is presence of virus in the whole body. In the second stage, when the HCV is tested, nothing can be found in the blood. In the third stage, the patients test positive for HCV and the blood is infested with the virus. In the fourth stage, though the virus is still found in the blood but the patients test negative for HCV.

The doctors say that the first two stages don’t require treatments, whereas medical interventions are must in the last two stages to prevent further deterioration in health. According to a Nepal government survey, 0.6 to 0.7 percent of Nepalese people are infected by the virus. The infection is more prevalent among people who use drugs (PWUDs). The statistics show that out of 4 million Kathmanduites, 24,000 are infected by the Hepatitis C virus.

Among the PWUDs, Hepatitis C is mostly transmitted through unsafe injecting practices. But the disease also gets transmitted by close association with the the infected ones or during tattooing. If not treated in time, it could lead to fibrosis and liver cirrhosis after 15-20 years. Excessive use of alcohol can also put people at risk of cirrhosis within five years of diagnosis, followed by liver failure. In the long run, the problem may also cause cancer of liver.

The treatment of cirrhosis at the initial stages of Hepatitis C is possible, but it is costlier compared to Hepatitis B, says Dr Sharma.

HCV affected mother can beget children infected with the disease. Across the world, there are approximately 130 to 150 million people affected by HCV. According to the WHO, around 3,50,000 to 5,00,000 people die every year because of HCV.

Sadly, no vaccine has been made yet against Hepatitis C.

HCV is found to be affecting patients in two major ways: chronic and simple. The simple infection of the HCV results in no visible symptoms and there is no threat to life. Such infection is seen in 15%-45% of the people and the condition can be cured within 6 months after the symptoms become visible. Meanwhile, chronic HCV affects 55%- 85% of people, out of which 15% to 30% of them are likely to become victims of liver cancer and Cirrhosis within 20 years of time.

Hepatitis C is found globally, but its severe effects are prevalent in central Asia and Eastern Europe, and North Africa. More than 80% of patients suffering from Hepatitis C show no symptoms. In various patients, symptoms like fever, tiredness, loss of appetite, vomiting, stomach ache, discolored urine, arthritis, and jaundice are seen.

The antiviral therapy (interferon and ribavirin) is the globally followed method for treating HCV. More than 80% of those infected with HCV tend to be PWUDs.  According to Nepal Liver Foundation out of 2,40,000 Nepalese people affected with HCV, 75,000 are chronic patients. Since the last two decades, the prevalence of HCV has increased due to the rise in the drug use with inadequate harm reduction practices.

According to an estimate, there can be 38000 liver cirrhosis and 4,000 liver cancer patients in Nepal in the next two decades. 

Chhatra Karki, Citizen News Service - CNS
10 May 2014