The first half of 2014 has been an important time for hepatitis C. A newly approved drug produced in the United States has given hepatitis patients treatment that’s more effective (and more expensive) than ever, while at the World Health Organization (WHO), a new report on hepatitis C diagnosis and care has just been released.
The report – entitled Guidelines for the Screening, Care and Treatment of Persons With Hepatitis C Infection – represents the first time in history that WHO has produced a set of health care instructions specifically related to the hepatitis C virus. Although previous guidance has been released on general care for blood-borne viruses, this new report offers a framework to medical personnel as well as policy makers working in populations where hepatitis C is common. It is estimated that over 185 million people are the world are currently suffering from hepatitis C, and each year, the virus causes 350,000 fatalities.
Hepatitis C is a virus, transmitted from person to person primarily through the blood. Infections can occur as a result of unsterilized medical equipment, the sharing of needles amongst intravenous drug users, unclean tattoo equipment, and blood transfusions from an infected individual. Once infected, a hepatitis C patient may experience liver problems such as scarring, cirrhosis and eventually cancer. At the same time, many people are asymptomatic while still testing positive for hepatitis C. Unlike other viral infections such as HIV, hepatitis C can be cured – a course of antiviral drugs will normally last for 12 to 24 weeks, curing 50 to 80 percent of patients. A new drug released earlier this year may boost that curative success rate to over 90 percent.
Still, despite the positive potential of pharmaceutical treatment, WHO and other health care groups strongly agree that it is far better to prevent hepatitis C in the first place. In the recently published Hepatitis C Guidelines, WHO explains that transmission of the virus can best be prevented with better sanitation standards at medical facilities around the globe. The majority of hepatitis C infections occur as a result of poor procedure at clinics; reusing medical equipment, for example. WHO recommends that to reduce viral transmission, health care clinics must follow basic sanitary guidelines: washing hands before and after touching a patient; using rubber gloves when necessary and properly disposing of them; cleaning equipment; testing donated blood before giving it to another patient; and more.
Along with prevention of hepatitis C, proper screening of at-risk populations is key to ensuring that the virus doesn’t spread. In its Guidelines, WHO recommends that individuals engaging in high-risk behavior, such as intravenous drug use, be tested for hepatitis C whenever possible using a simple blood test. Amongst communities in which use of unsterilized medical equipment is the norm, testing for hepatitis C should be frequent and possibly extended to every member of the population. WHO also suggests that because those at risk of contracting hepatitis C may also be at risk of HIV and other blood borne illnesses, these disease can be tested for at the same time.
When it comes to caring for patients who have contracted hepatitis C, WHO writes in its Guidelines that long-term management is key: two, three or even four decades may pass between the original viral infection and the medical effects of the virus such as cirrhosis of the liver. According to WHO and other leading medical organizations, hepatitis C patients should be discouraged from excessive alcohol use. Alcohol will quicken hepatitis C’s damage to the liver, leading to more scarring more quickly and a higher risk of cirrhosis. Intervention through counseling or a substance abuse support group may be necessary for hepatitis C patients who endanger themselves with excessive drinking. Counseling could also be useful for informing hepatitis C patients about how the disease is spread, and how their intravenous drug use could lead to viral infections in others.
In terms of treatment, the WHO Guidelines state that every hepatitis C patient should be given pharmaceutical treatment, when possible and appropriate to that patient’s individual health status – and the earlier the treatment, the better. The benefits of antiviral treatment on hepatitis C patients are huge, with cure rates getting higher and higher every year. New medications can stop the hepatitis C infection, and prevent future health problems such as cirrhosis and cancer. Unfortunately, drug therapy for hepatitis C is expensive, with one newly released curative treatment being sold for US$1,000 per pill – a price tag that is unaffordable for a great many patients. WHO recommends that health care staff be trained in how to administer hepatitis C treatment programs, and that whenever economically possible, drug treatment be made available to patients. Although the WHO Guidelines admit that some antiviral medications may cause adverse side effects including flu-like symptoms and depression, report writers still argue that the fatality rates of hepatitis C necessitate the use of medicine – and with new research and new drugs on the market, side effects of hepatitis C treatments may soon be reduced.
Besides addressing hepatitis C patients in general, the WHO Guidelines also offer recommendations for specific populations likely to suffer a hepatitis C infection. Report writers note that around 67 percent of intravenous drug users throughout the world are already infected with hepatitis C, and in order to care for this huge population of patients, medical workers should act without discrimination; offering screening, treatment and psychological support as needed. WHO also recommends that in such populations, clean needle programs should be provided, to minimize the risk of transmitting hepatitis C and other viral infections such as HIV. In populations suffering from both hepatitis C and HIV, the WHO Guidelines warn that HIV can quicken the effects of hepatitis C on the liver, but that hepatitis C drugs can be dangerous to an HIV sufferer already undergoing a heavy regimen of drug therapy – therefore, patients with co morbidity of these two diseases should first stabilize any health problems related to HIV, before moving on to treatment for hepatitis C.
To read more about WHO’s inaugural Guidelines on hepatitis C interventions and treatment, see the report online.