REAL LIFE: Battling Hepatitis C

The major problem regarding Hepatitis C (Hep C) and other viral diseases in Africa is two-prong: Treatment is prohibitively expensive and diagnosis is irregular. This means that many of people suffering from Hepatitis of any type do not know they have it, and those who have been diagnosed with Hepatitis cannot afford the treatment. Sometimes those who have been diagnosed and can afford the treatment are sometimes unable to tolerate treatment because of their age or because of damage already done to the liver or the kidneys. Thus, while Hepatitis is not a death sentence, it can be a death sentence for certain age groups. My personal battle with Hepatitis C Genotype 4 may be instructive. I was diagnosed with my particular infection in 2011. The problem with HEP C genotype 4, which I had, is that it is rare, occurring in North Africa, the Middle East and some parts of Central Africa. There is no specific treatment for Hep C Genotype 4. There are currently a few clinical trials for Hep C genotype 4 at the University of Chicago, at Johns Hopkins University and at other centers, but it will take some time before the results of the trials are known and approved by governments. I was, therefore, treated with a drug called Harvoni, which is approved for Genotype 1, but not Genotype 4. Treatment was available in the US because Harvoni was not available in East Africa at that time. The treatment consists on one pill per day for three months. At that time the cost was $ 1, 200 for the single pill; the total cost for the course of three months was $ 108, 000. I was fortunate that the drug manufacturer, Giliad Sciences, donated the drug to me free of charge and I do not have the virus any more. The good news is that the Ministry of Health in Rwanda is in the process of negotiating the reduction of the cost of Harvoni and it is likely to be made available in Rwanda within a month’s time. This will be a great relief to many victims of HEP C and will save hundreds of thousands of Hep C victims. However, age will continue to be a factor, for people who are diagnosed late in life; people in their late 60s or 70s may not be able to tolerate the treatment though Harvoni has practically no side effects. As in cases of cancer, early detection and diagnosis is essential as Hepatitis has no symptoms in the early stages. What is Hep C? Hepatitis C, also called HCV, is a virus that can cause both chronic (long term) and acute (short term) infections of the liver. Symptoms can develop as early as six months of exposure to the virus. According to the United States Centers for Disease Control and Prevention (CDC), there is an estimated 8 million people in the world who have chronic hepatitis C. Currently, there is no vaccine available for hepatitis C, but the governments in Europe and the US are working on developing one in the near future. Causes The Hep C virus is a blood borne pathogen, meaning that it is transmitted through blood. In the past, HCV can be contracted through blood transfusions and organ transplants, as well as blood contamination in medical settings. It can also be transmitted in unlicensed saloons if nails are cut with instruments that are not sterile. Today, such risks are drastically reduced, and hepatitis C contraction is limited by sharing needles or injection equipment between an infected person and a non-infected person. It may also be transmitted through unprotected sex. Symptoms and signs Acute hepatitis C patients can recover without treatment and leave no symptoms, so the infection can go undiagnosed. Chronic hepatitis C can display symptoms, but it can take up to 30 years after obtaining the virus for them to appear. They are similar to other hepatitis infections, as they all target the liver. They may include, but are not limited to: fever, itchy skin, fatigue, loss of appetite or anorexia, nausea, vomiting, abdominal pain, dark coloured urine, grey coloured stool, joint pain, jaundice, tenderness in the liver area, swollen stomach or ankles, spider-like thin blood vessels that develop on the skin. If you suspect you have the HCV, be sure to see a doctor immediately to start taking measures to manage the virus. Treatment Treatment campaigns are required so that early interventions can be made. Screening and referral to care are not expensive and require only blood tests, which are available locally in Rwanda. It is certainly hoped that the Rwanda Ministry of Health will establish health screening through the Metuelle de Sante insurance scheme so that the general population can detect both communicable diseases (HIV, Hep C) and non-communicable diseases like cancers. The World Health Organisation (WHO) has established guidelines highlighting varied screening approaches, recommending targeted screening of individuals with high-risk behaviours, or those who reside in high prevalence areas like Rwanda. Implementation of targeted screening would require an understanding of the population-level incidence in many countries. While there is a vaccine for Hepatitis A and B, there is no Hep C vaccine. Therefore, early diagnosis and treatment are the only options for the patient. Early diagnosis and treatment are the only options for the prevention and elimination of the virus. Diagnosis and Treatment To confirm the presence of Hep C, a blood test is needed to test the presence of antibodies (which are developed by the body in an attempt to battle the virus). Those who have contracted but recovered from the virus can still test positive for the HCV antibody. When the presence is confirmed, the doctor will run additional tests to determine if the infection has been cleared or has become a silent, chronic infection. Hep C is managed through frequent medical visits, along with much rest, good nutrition, plenty of fluids, and prescribed antiviral medications to slow down liver damage. The doctor will monitor closely for signs of liver disease or cancer. During treatment, it is important to stay away from alcohol and over the counter medications and supplements (unless approved by the doctor), as they all cause stress and further damage to the liver. Sometimes, the virus can clear up with proper treatment. In the case of liver failure due to HCV, a liver transplant may be an option, but Hep C monitoring will still need to continue afterwards as it is a blood borne disease. Complications For those who develop symptoms, 15 to 20 percent of the infections are acute and recover naturally. The rest of them, about 75 to 85 percent, become chronic patients with a chance of developing serious liver problems. Some complications may include chronic liver disease and cirrhosis (scarring of the liver tissue). The other damages to the liver are liver cancer and liver failure. Usually, only one to five percent chronic patients will die of liver disease. Be sure to follow all directions clearly for the most effective management, as damage to the liver can still happen even if symptoms are gone. Most patients do not die from the viral infection itself but from the complications resulting from liver damage. As the slogan goes for all infectious diseases, early detection is the best prevention. If you suspect that you have Hep C, go to the doctor and get a diagnosis. Even when you have no symptoms, get tested so you can rule the scourge of the viral infection. The author of this article is a retired educator. He promotes awareness of Hep C because he is a survivor from the viral infection. No one should regard this account as a medical opinion but rather as general information everyone should have to protect him or herself against the disease.