Hepatitis C in India – An emerging scourge

Hepatitis C infection is spreading fast in India and over one lakh people get infected by the deadly HCV virus every year, according to the Indian National Association for the Study of Liver (INASL) study.

Nearly 12.5 million Indians are suffering from Hep C disease affecting the liver. Every 15th carrier of the Hepatitis C virus is an Indian, according to a recent report. At present, nearly 12.5 million Indians suffer from the virus. Caused by one of the of five known hepatitis viruses — A, B, C, D, and E –hepatitis C infection, very often, presents no noticeable symptoms at the beginning.

In the first 6 months after infection with HCV — the acute hepatitis C — a minority of patients show symptoms like that of in other forms of hepatitis infection including loss of appetite, fatigue, abdominal pain, jaundice, itching etc.

Chronic Hepatitis C

60-85% of patients infected with HCV develop chronic hepatitis C, i.e., infection lasting more than 6 months. As the HCV infection progresses it can lead to scarring of the liver. This scarring, often referred to as fibrosis could advance to more dangerous liver cirrhosis. Liver cirrhosis may cause liver cancer and in some cases, liver failure.

‘Hepatitis C is responsible for as many as one in four cases of liver cancer and 20 percent of chronic liver disease is because of Hepatitis C,” says Dr S K Acharya, professor and head of the Gastroenterology department at the All India Institute of Medical Sciences, New Delhi – one of India’s pioneering medical institutions.

Generally, the hepatitis C virus (HCV) is spread through blood infected with the virus. Once in the blood stream, the virus will remain in the liver in most – nearly 80% –of the cases.

HCV infection is commonly treated with anti-viral drugs like ribavirin along with immune system stimulating agents like interferons.

There is no vaccine available to prevent hepatitis C infection. Chimpanzees are the only other organism hepatitis virus infects, apart from humans.

Worldover, 150-200 million people are estimated to be infected with hepatitis C.

Hep C transmission

How is the infection caused? The most common risk factor for hepatitis C infection today is drug use through intravenous (IV) – directly into the vein- route, especially through sharing of contaminated needles, according the 17th annual conference of the Indian National Association for the Study of Liver. In fact, 60 per cent to 80 per cent of all IV-drug users are infected with the HCV. Other risk factors include tattooing and body piercing if the tattoo/body piercing needles are not properly sterilized.

Hepatitis is not easily spread through sexual intercourse. However, high-risk behaviour, such as multiple sexual partners, is associated with an increased risk of HCV. Blood transfusions are another leading cause of HCV where unsuspecting patients are given blood which has the Hepatitis C virus, experts say.

How does one know he/has HCV infection? Hepatitis C virus is usually detected through a blood test. The polymerisation chain reaction (PCR) test is conducted within one to three weeks after infection. The antibodies to the virus are generally detectable within 3 to 15 weeks.

Approximately 15-40% of persons infected with HCV clear the virus from their bodies during the acute phase. This can be confirmed by liver function tests (LFTs) to check the normalisation of alanine transaminase (ALT) & aspartate transaminase (AST), as well as plasma HCV-RNA clearance (this is known as spontaneous viral clearance).

The key to successfully tackling the challenge of chronic hepatitis lies in creating awareness and through better public education in India.