Affordable Hepatitis Care in India

The most common cause of hepatitis is virus. It is caused by hepatitis viruses A through E. An estimated 40 million people in India have chronic hepatitis B infection, constituting approximately 11% of the estimated global burden. Hepatitis C affects about 12 million patients in India. Both of these blood-borne infections have a high risk of progression to advanced liver disease and are associated with the development of hepatocellular carcinoma, a type of liver cancer. The need of the hour is increased access to high quality, affordable and effective therapy in India.

Prevention

Viruses transmitted via the fecal-oral route (HAV and HEV) can be effectively controlled with the institution of proper sanitary conditions and provision of clean and safe drinking water. Preventive strategies for HBV and HCV include an active screening of the high-risk groups, stringent application of public based surveillance programmes and development of educational curriculum targeting not only the high-risk groups but also the general population. Effective vaccines are now being employed in the preventive strategies against viral hepatitis and coupled with other measures can help effectively tackle the burden of viral hepatitis in India.

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Treatment

The standard treatment option for Hepatitis B and C is to give medications to treat the viral infection and keep the liver healthy. The currently approved drugs for Hepatits B are

  1. Nucleoside Analogs [Baraclude (entecavir), Epivir-HBV (lamivudine) and Vemlidy (tenofovir alafenamide)] which suppress the replication of the virus and have few side effects. However, drug resistance is common and they need to be taken lifelong to prevent recurrence.
  2. Pegylated Interferons (PEG-IFN) interfere with viral multiplication and enhance an immune response to against the virus. It has the benefit of the limited duration of treatment. These include Intron A (interferon alfa-2b), Hepsera (adefovir dipivoxil), Pegasys (peginterferon alfa-2a) and Viread (tenofovir disoproxil fumarate). However, they have side effects like depression, paraesthesia, myelosuppression, and other influenza-like symptoms such as fatigue, headaches, and weight loss.

The drug used to treat hepatitis C is called Sofosbuvir, an antiviral drug which inhibits the functioning of an enzyme present in the hepatitis C virus (HCV). In addition, DAAs (direct-acting antivirals) Daclatsavir (Daklinza) and Ledipasvir/Sofosbuvir (Harvoni) are also used to improve the treatment outcome of people infected with HCV. Most patients are cured with three months of treatment. Patients with advanced disease or who have failed treatment in the past may require treatment up to 6 months. The drug of choice depends on the type of hepatitis C virus causing the disease.

  1. Patients with Genotype 1 and 4 infections: Harvoni (Sofosbuvir / Ledipasvir) for 3 months
  2. Patients with Genotype 2 infection: Sofosbuvir and Ribavirin for 3 months
  3. Patients with Genotype 3 infection: Sofosbuvir and Daclatsavir for 3 months
  4. Patients with cirrhosis: Treatment should be extended to 6 months to achieve optimal response

Viral hepatitis poses a major health care burden in India and hence, strategies to effectively control the problem are needed.