By Rupesh Dutta
The parents of 31-year-old Naina Bharali are worried since their only daughter has been diagnosed with cirrhosis (liver cancer) -- caused by the hepatitis C virus. She is four months pregnant and they fear the new born will also get infected by the blood-borne viral disease.
The confused Bharali does not know how she got the disease, but doctors she is consulting on a regular basis suspect she received infected blood almost a decade ago when she had met with an accident. Now, the only priority for Bharali's parents is to get her proper medication and prevent her foetus from getting affected by the hepatitis C virus (HCV).
"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.
According to an Indian Society for Clinical Research, the country "carries a high burden of this disease...has 17 per cent of the global population and 20 per cent of the global disease burden.
"But less than 1.4 percent of all global clinical trials are done in India," according to an ISCR statement issued on Friday.
President ISCR Chirag Trivedi said it "is crucial for us to scale-up clinical research for many of our public health challenges, including hepatitis."
Last year, the then president, Suneela Thatte, had said in a press release that hepatitis C alone affected an estimated 12 million people in India.
More worryingly, there has been an eight per cent rise in the number of HCV cases among pregnant women in the 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.
Sofosobuvir, Ledipasvir Ribavarin, Veltapasvir, Grazoprevir, Elbasvir and PEG-Interferon are some of the latest drugs against HCV.
Sofosbuvir is a direct-acting antiviral drug that targets different steps of the HCV lifecycle. The medicine blocks the polymerase enzyme that the virus uses to replicate.
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.
(Rupesh Dutta can be contacted at Rupesh.email@example.com)