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Posted: 07 April 2006

GPs and public health doctors encouraged to check for Hep C

Known as the hidden epidemic, more people suffer from the Hepatitis C virus than from HIV. Globally 170 million people are infected with Hepatitis C; possibly twice as many as are infected with HIV.

Perhaps the reason so little attention is given to Hepatitis C is because, until 1989, it was unknown as a distinct virus and was included in the "non-A non-B classline" as a viral infection different to Hepatitis A or Hepatitis B.

The most commonly known cause of transmitting Hepatitis C is by contact with infected blood so those at high risk of infection included patients who received blood transfusions or blood products before the introduction of routine blood screening in the early 1990s (including people with haemophilia, organ transplants, chronic renal failure and cancer requiring chemotherapy, along with some mothers given blood with anti-Rhesus factor), intravenous drug users, those with large numbers of sexual partners, children born to infected mothers, and healthcare workers who suffer needlestick injuries. However a number of individuals have become infected with HCV who do not have the classic risk factors. Therefore the other modes of transmissions exist.

But, of great concern to the medical specialists is the likelihood that only 15% of Hepatitis C cases are diagnosed. “The infection for those who received blood in the pre-1990s period is an absolute tragedy.” Virus specialist, Dr Jeff Connell from UCD said. "And, we are aware of the high risk among intravenous drug users, those who get tattoos from unreliable sources and even those who practice high-risk sexual behaviour. But, the transmission route for the virus is not well defined beyond those areas and in around 30% of cases the route of infection is unknown.”

Cases of Hepatitis C only became notifiable in January 2004. The low detection rate means that the Health Protection Surveillance Centre cannot accurately quantify the number of cases in Ireland but is trying to build up a national data base. The UCD/Roche conference organisers (Saturday 8 April 2006) hope to encourage GPs and public health professionals to watch out for symptoms and to send patient samples for screening if there is a possibility that they may be carrying the virus.

Perhaps up to 40% of sufferers are unaware that they carry the virus because they are asymptomatic. They display no distinct symptoms until they are at a chronic stage of the disease and the symptoms they do exhibit are mild and intermittent. They may complain to their GP of fatigue, anxiety, loss of appetite, nausea, muscle and joint pains or mild, upper right abdominal tenderness. Symptoms that are easily attributed to other ailments and diseases.

20-30% of people infected with Hepatitis C clear the virus from their body within six months without treatment. For the remaining 70-80%, the early symptoms may be mild and the virus may take 20-30 years to emerge in a chronic state – by which time it is difficult to treat. Primarily the virus attacks the liver causing cirrhosis with complications such as jaundice, ascites, bleeding veins, encephalopathy (brain disease) and rapidly resulting in end-stage liver disease requiring liver transplant. Estimates suggest that one third of patients waiting for liver transplants have Hepatitis C virus related disease.

Routinely, the normal blood screening for Hepatitis C detected the antibodies generated by the body to fight the virus. However, there is a delay between an individual becoming infected and being able to detect the antibodies to Hepatitis C virus. During this period the infected person is highly infectious. The antibodies may survive even after the virus has been eradicated by the body. But, in recent months a new test has become available to Dr Connell and his team at the NVRL (National Virus Research Laboratory) at UCD. “For the first time we can actually detect the virus and the antibodies in the same test. This enables earlier detection of recent Hepatitis C infection. Once the infection has been identified molecular techniques can be used to genotype the virus and also determine how much virus the person has circulating. Both of these are necessary for optimal patient management.

Studies suggest that in this decade there will be a six-fold increase globally in the number of patients who develop cirrhosis. However, recent advances in the treatment for Hepatitis C have dramatically improved the chance for a cure. Improved detection and early intervention with pegylated interferon/ribavirin combination therapy is the optimal treatment.

“We hope that, by bringing GPs and public health practitioners here to UCD, we will raise the awareness of the prevalence of Hepatitis C among Irish people and encourage them to consider the possibility of the virus when patients present with symptoms not associated with Hepatitis.” Dr Connell said.

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