The World Health Organisation (WHO) has recently released a report detailing guidelines for managing Hepatitis-C. The guidelines are primarily for policy-makers and those working in low- and middle-income countries who formulate country-specific treatment guidelines and plan treatment programmes for infectious diseases.
The objective is to provide evidence-based recommendations on screening for Hepatitis-C virus (HCV) infection, and care and treatment of affected people. The guidelines are also meant to provide a framework for the development or strengthening of Hepatitis-C treatment programmes.
In South-east Asia, the prevalence of Hepatitis-C is 2 per cent and about 11 million people suffer from it. A recent paper in an Indian medical journal says Hepatitis C virus (HCV) has emerged as a leading cause of chronic hepatitis, liver cirrhosis and liver carcinoma.
People at high risk of contracting Hepatitis-C are those who inject drugs, who have received infected blood products or have undergone surgery and got infected, children born to women with HCV, people who have sex with those infected with HCV, people with HIV infection, those who inhale drugs as well as those who have tattoos or piercings.
The report says, “These are the first WHO guidelines on screening, care and treatment of people with HCV infection. They are intended to complement existing guidelines on the primary prevention of HCV and other blood-borne viruses by improving blood and injection safety, and health care for people who inject drugs (PWID) and other vulnerable groups, including those living with HIV. The document will be revised in 2016. As a number of new medicines are expected to become available in the meantime, WHO will issue interim guidance twelve months after publication of these guidelines to provide recommendations regarding newly-approved medicines.”
Devaraja, Joint Director, Department of Communicable Diseases under the Health and Family Welfare ministry, says, “There is no management of Hepatitis-C in the State as the drugs are not available. The disease is transmitted through infected blood, so prevention of infection is necessary.”
The report has a section on special considerations for specific populations that includes information for people who inject drugs, people with HIV and HCV co-infection, children and adolescents.
High risk of liver cirrhosis
One-third of those who become chronically infected are predicted to develop liver cirrhosis (liver does not function as tissues are dying) or cancer of the liver. The Hepatitis-C virus is small with a highly variable genome and multiple genotypes and subgenotypes which vary in different areas of the world. Some genotypes are easier to treat and medicines for therapy vary by genotype. That is why getting a patient’s genotype is important for appropriate therapy.
Early Diagnosis of chronic HCV critical
The report says, “In many countries, people have very limited access to HCV testing and thus, remain undiagnosed until they present at a health centre with symptoms of cirrhosis or liver cancer. Testing at this time is referred to as “symptomatic testing.” At this point, HCV-induced liver damage is often advanced and therapy may be contra-indicated. Therefore, it is critical to identify approaches that will lead to a diagnosis of chronic HCV infection earlier in the course of disease.”