July 28 is the World Hepatitis Day
Viral hepatitis contributes to a significant number of deaths and to the global economic burden. Not only do we need to strengthen our prevention strategies, but we also need to focus on factors that affect the treatment of hepatitis. Here are some challenges to hepatitis treatment that we need to overcome.
1. Poor screening: Dr Avnish Seth, Gastroenterology & Hepatobiliary Sciences Director, Fortis Organ Retrieval & Transplant, Fortis Memorial Research Institute (FMRI), Gurgaon highlights the importance of screening of high risk individuals for an appropriate treatment approach. 'People with a history of exposure to hepatitis virus, healthcare workers and pregnant women are some examples of high risk individuals who need to be screened within time,' he says. Once screening is delayed, it gives an opportunity to the virus to develop an acute infection. Delayed diagnosis can also give rise to chronic infection and cause further harm to the liver.
2. Poor healthcare access: Hepatitis A and E are prevalent in areas where poor sanitation and poor hygiene practices are largely prevalent. Unfortunately, these are the areas where the outreach of healthcare services has not yet been maximised. Therefore, early screening and treatment takes a back seat and more and more people develop infection. 'According to the notification received by the Integrated Disease Surveillance Programme of the National Centre for Disease Control (NCDC) 290,000 cases of acute viral hepatitis occurred in the 2013,' says Dr Seth.
3. Co-infection with HIV: Peoplewith HIV arevulnerable to a lot of diseases and hepatitis C is one of them. The most challenging part in such cases is that the interferon treatment administered for hepatitis C interferes with antiretroviral drugs given for suppression of HIV. However, the recently approved drug sofosbuvir has shown promising results for treating HCV in people with HIV. Hopefully, the drug will soon be made available in India.
4. Cost-effectiveness of treatment: A major part of the population suffering from hepatitis belongs to the group that cannot afford costly treatment and vaccination. Hepatitis C treatment may alone cost Rs 1.5 lakh, while hepatitis B treatment may cost about Rs 50,000. Treatment and therapies should be made affordable without compromising on the quality. Even for the introduction of new drugs and therapies, cost should be a major factor taken into account.
5. Non-adherence to treatment: Hepatitis treatment may last upto one year for a sustained rate of response against the virus. The longer the treatment, the likelier are patients to deviate from it. Most of them stop the treatment abruptly because they either start feeling better or they cannot afford to continue the treatment.
6. Silent infection: Oncea person is infected with hepatitis B, he may not get completely cured. The virus may get suppressed but complete elimination from the body may not be possible even after rigorous therapies. 'HCV are silent killers as they lead to persistence of virus with virtually no symptoms until there is significant damage to the liver, says Dr Seth. A person may carry the virus for as long as 10 to 20 years without developing any symptoms. Such patients are potential carriers that spread the disease. Identification and treatment of such patients is very difficult.
In order to improve the treatment, we need to identify high-risk individuals with progressive disease; we need a combination of various strategies at all levels and we need to improve treatment literacy by integrating it in national programs. 'Surveys on impact of immunization policies suggest that better central and district level control, regular vaccine supply and training may help in smooth implementation. Also, there is a need to involve private practitioners in implementation of HBV vaccination program. As per a recent global policy report (2013), India still needs to work in areas of generating data for evidence-based policies, implementing preventive measures, raising awareness and partnerships, and screening and management of viral hepatitis,' says Dr Seth.
Image source: Getty images
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