Chronic Hepatitis C

Hepatitis C was first discovered in 1989. Worldwide prevalence is around 1.8% of blood donors. The population in Thailand is approximately estimated that 6 hundred thousand to a million people are infected with this disease. There are 6 genotypes of hepatitis C. In Thailand, 40-50% has been found to be genotype 3, followed by genotype 1 around 20% and genotype 6 for 15-20%.

Hepatitis C virus transmitted by receiving contaminated blood or blood products, or from syringe, razors, tattoo or acupuncture equipment that is contaminated with patient’s blood. The disease transmission via sexual contact between husband and wife is very rare but the possibility is higher in people who are sexually promiscuous up to 0.4% per year. The chance of transmitting from mother to fetus is found at 4-7%.

As the disease progression continue after exposure to hepatitis C, 20% of acute hepatitis patients are found to have jaundice where more than 80% will go into chronic hepatitis with 20% of liver cirrhosis progression in 20 years and 20% of liver cancer incidence 5 years after cirrhosis. However, there are other factors that cause the disease to progress faster, including alcoholic drinking, gender (males), ages (over 4 years old), and concomitant infection with hepatitis B virus or HIV.

Diagnosis of chronic hepatitis C can be done by detecting Anti-HCV immunity which provides an accuracy of 92-99%. Therefore, it is commonly used in patient screening and can be confirmed by using HCV RNA for the amount of C virus in the blood. This is useful to tell the likelihood of response to treatment and see the trend of response during treatment.

Treatment of chronic hepatitis C aims to:

1. Eradicate hepatitis C virus to prevent transmission to other people.

2. Reduce inflammation in the liver, slow down fibrosis to reduce the incidence of cirrhosis and liver cancer.

3. Reduce the death rate from liver disease and increase quality of life

Currently, the drugs used to treat chronic hepatitis C are Pegylated Interferon and Ribavirin. The treatment takes around 6-12 months depending on the genotype. They are very expensive. The problem is that the costs associated with the drug have many side effects. They should be used under supervision and monitoring for side effects by a specialist from applying Interferon. The side effects include fever, aches, fatigue, weight loss, thyroid, and bone marrow suppression. Ribavirin is an oral drug that can cause hemolytic anemia, rash, cough, dizziness. In addition, patients must perform contraception during treatment until or after stop taking the drug for 6 months due to the effect of Ribavirin to the fetus.

Although the cost of treating chronic hepatitis C is very expensive, it is found that the treatment using Pegylated Interferon and Ribavirin can provide preventive benefits from cirrhosis liver failure and liver cancer. It also gives value in terms of life (quality and long-term living) and more cost-effective compared to hemodialysis in patients with chronic renal failure coronary artery surgery and long-term treatment of high blood pressure.