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Health, Beauty & Fashion

Silent killer

Hepatitis sufferers display symptoms of the malaise only in its advanced stages.
The Business Times - July 28, 2012
By: Cheah Ui-Hoon
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Silent killer On the treatment of Hepatitis C using a new oral tablet, Victrelis (above), the first anti-viral agent specifically designed for HCV - PHOTO: JASON QUAH

HEPATITIS C isn't one of the conditions you hear about often in Singapore, seeing as Hepatitis B and A are much more common

here. However, there is still a small number of Hepatitis C (HCV) sufferers out there who could benefit from a new drug.

"Hepatitis C is a more common condition in the United States and Europe. It is the leading reason for liver transplantation in the US," says Prof Lim Seng Gee, senior consultant, Department of Gastroenterology & Hepatology, National University Hospital.

HCV is usually transmitted through transfusion or transplant from an infected blood donor, unsafe injections, accidental injuries with needles or sharp objects, multiple sex partners, or it can be inherited at birth from an HCV-infected mother. "Tattooing and acupuncture could be potential sources of infection, if needles aren't used properly. Also, roadside dental clinics and barber shops," says Prof Lim.

HCV was discovered not too long ago, in 1989; and the first diagnostic tests for it was available in 1990. It's more of a disease in the West, while Hepatitis B affects more Asians.

The rate of infection differs from country to country. In Singapore, there's no good data on HCV infection, but it's believed to be low. A 1996 survey showed that among blood donors, 0.37 per cent were found with HCV.

Cure rates for Asians are 50 to 75 per cent, says Prof Lim, adding that cure rates for Caucasians are lower, at 40 to 50 per cent. "That's because they carry genetic markers that make them more resistant to treatment. Also, there are different strains of the virus, with some genotypes requiring longer treatment," he adds.

While Asians are more responsive to treatment, there are still those who are not. For those, there is now a new oral tablet to help. Victrelis (brand name for boceprevir) is the first anti-viral agent specifically designed for HCV.

It has to be used in conjunction with the standard care. Added to the standard injections and another oral medication, the triple therapy leads to a higher response rate, notes Prof Lim. "Those who have previously failed therapy may see response rates with 60-70 per cent compared to the 20 per cent with standard care," he explains.

Because Singapore is one of the first countries in the region where this drug is approved, he expects to see a lot of regional patients coming here for treatment.

HCV leads to the same outcome as Hepatitis A or B, which is liver failure or cirrhosis. "The key difference is that HCV is curable. If a patient's liver was normal before treatment, then they can go back to normal life after completing treatment," he says.

While doctors aren't seeing many new infections of HCV they do notice the problem of under-diagnosis. "Under-diagnosis happens because patients had caught it somewhere, some time in the past," says Prof Lee.

Then there are more patients who aren't responding to treatment. This is because these patients already have advanced liver cirrhosis, or other complications like diabetes, fatty liver, weight problems and so on. "All of these will make them less responsive to treatment. Or they could have genotypes that make them less responsive," he explains.

Meanwhile, the public should note that hepatitis has been elevated by the World Health Organisation to be a disease of the same magnitude as tuberculosis and HIV. That's because hepatitis is the second most common medical cause of deaths worldwide, after HIV; and the fourth most common cause of cancer. It's in the same league as say, car accidents.

Because it's a silent disease, patients don't display symptoms until the condition is in the advanced stages. So, the best way to monitor this is through regular blood tests, which isn't currently practised.

Hepatitis C testing is currently not included in corporate health check-ups, for example, points out Prof Lee. "While Hep B testing is done routinely, HCV testing isn't. But we're trying to raise awareness that if you're going for a routine healthcheck, you should also test for HCV," he says.

Ths is especially important as the disease can be effectively controlled, and effect a significant difference in a person's liver health, and health in the long run.

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