Naina Bharali’s parents are having sleepless nights as their 31-year-old daughter Naina Bharali has been diagnosed with cirrhosis (liver cancer) which is caused by Hepatitis C virus. Naina is four months pregnant and expectedly, her baby will also be infected by the viral disease. Devastated woman doesn’t know how she contracted the disease. But the doctors are suspecting that a decade ago when she met with an accident, she received infected blood. Now the doctors and her family are trying their best to save the unborn from the Hepatitis C virus.
"A child born to a HCV-positive mother has a 90 per cent chance of carrying the viral infection. Such children usually develop chronic HCV and, without treatment, progress to chronic liver disease and liver failure," Manish S. Bhatnagar, Consultant Gastroenterologist and Hepatologist cum Director of Ahmedabad's Icon Hospital, told IANS.
The study by Indian Society for Clinical Research suggests that around 12 million people in the country are affected by HCV, which is the second highest globally. 8% rise in the number of cases among pregnant women has risen up since last one decade.
Experts say that babies born with HCV often have a mild liver disease and around 80 per cent have very low to no liver scarring in the first 18 years. However, the actual nature of the disease becomes apparent once the child reaches adulthood as HCV usually takes more than a decade to cause liver problems -- but whenever it happens, it is disastrous.
The Hepatitis C virus can cause both acute and chronic hepatitis, ranging in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Most common modes of infection are through exposure to small quantities of blood. This may happen through injection drug use, unsafe injection practices, unsafe health care and the transfusion of unscreened blood and blood products.
Bhatnagar said that HCV cases in women are fast increasing due to unsafe injection practices, promiscuity and unsafe sex, unsanitary delivery practices, rising intravenous drug use and usage of unsafe blood products from unregistered blood banks.According to global health bodies, an estimated 71 million people have chronic hepatitis C infection. A significant number of them will develop cirrhosis or liver cancer. Approximately 399,000 people die each year from hepatitis C, mostly from cirrhosis and hepatocellular carcinoma.
Neerav Goyal, Senior Consultant -- Liver Transplant, Indraprastha Apollo Hospitals, said HCV in pregnant women in India has been reported more from rural areas compared to urban areas.
"One of the reasons attributed is the increased incidence of anaemia in the rural population with a consequent higher chance of using contaminated needles and syringes for its treatment. A higher incidence has also been reported from multigravida, where previous pregnancies, hospital admissions, obstetrical surgeries and blood transfusions have lead to an increase incidence of HCV infection," said Goyal.
According to the All India Institute of Medical Sciences, transfusion of unscreened blood in patients till 2002 had been one of the major reasons behind spread of Hepatitis C. Following 2002, the government has been strict on measures against infected blood.
Commenting on cases of HCV among pregnant women, Roy Patankar, a prominent Mumbai-based gastroenterologist and Director of Zen Hospital, said that as the impact of this illness on children is not as much in the initial days as that of an adult, many doctors opt for a wait-and-watch approach. Until they reach an appropriate age for therapy, doctors do not prefer any treatment.
Antiviral medicines can cure more than 95 per cent of persons with HCV infection, thereby reducing the risk of death from liver cancer and cirrhosis, but access to diagnosis and treatment is low. There is currently no vaccine for HCV, but research in this area is ongoing.
"HCV can usually be treated using antiviral medicines, although currently there is no vaccine for HCV, research is on. Recently, few Indian firms have received licenses to manufacture HCV drugs as the country's capabilities in generic manufacturing, where quality and low cost co-exist, is quite well known," said Patankar.
As far as research on the development of new medicine for HCV is concerned, a lot of effort is being put in worldwide. However, most of the breakthrough drugs have come from the US and Europe so far. India's pharma prowess has ensured the lowest rates of these antivirals, thereby making them accessible to most of the patients.
Ramesh Garg, Senior Consultant at Gastroenterology at the city-based Saroj Hospital, said that earlier, HCV treatment was difficult and came with a lot of side effects, but since the advent of direct acting antivirals, there have been significantly higher cure rates.
Sofosobuvir, Ledipasvir Ribavarin, Veltapasvir, Grazoprevir, Elbasvir and PEG-Interferon are some of the newest drugs used to treat the HCV. Sofosbuvir is a direct-acting antiviral drug that affects different steps of the HCV lifecycle. The medicine blocks the polymerase enzyme that the virus uses to replicate.
(With IANS Inputs)