Doc Talk

New hepatitis C treatments have excellent outcomes

Posed photo of a doctor giving a jap after disinfecting the site of injection with an alcohol swab.
Posed photo of a doctor giving a jap after disinfecting the site of injection with an alcohol swab. PHOTO: THE NEW PAPER FILE

With early detection and treatment, patients have over 90% chance of a cure

Mr Y, a 72-year-old grandfather of four, was diagnosed with hepatitis C about 15 years ago.

Two years ago, he was referred to our liver centre after an ultrasound scan revealed a tumour in the liver. Further investigation confirmed that he had liver cancer.

Fortunately, his tumour was still in its early stages of growth and could be removed surgically. It was successfully removed and he was discharged from the hospital without complications. The pathology report confirmed that he had stage 1 cancer with liver cirrhosis (scarring of the liver).

After recovering from his operation, Mr Y started hepatitis C treatment. Unfortunately, he suffered adverse side effects. At that time, newer forms of medication, such as direct-acting antivirals, were not yet available.

When these medications were made available a year later, he started a new course of treatment.

The new regimen was successful and he had minimal side effects. He currently has no detectable levels of hepatitis C virus in his bloodstream. He diligently monitors his liver by going for regular blood tests and scans.

This year, more than 240 million people around the world have been diagnosed with long-term chronic liver infections.

Most people think liver diseases are caused by alcohol or drug- related issues. But there are more than 100 varieties of liver diseases.

One of the most common causes of these diseases is viral hepatitis. The hepatitis C virus, in particular, causes inflammation of the liver. This can lead to chronic hepatitis and raise the person's risk of liver failure, cirrhosis and liver cancer.

A hepatitis C patient is also vulnerable to other strains of the virus, such as hepatitis A and B.

  • Background Story

  • If you are a hepatitis C carrier:

    WHAT YOU SHOULD DO

    • Get vaccinated against hepatitis A and B.

    • Consult a liver specialist.

    • Practise safe sex by using condoms, and inform your partner so that he or she can be tested.

    • Cover up all open soresand wounds.

    • Monitor your liver health, and visit your doctor regularly to check on the progression of the disease.

    • Inform your doctors and dentists that you are a hepatitis C carrier when going for check-ups.

    • Stay informed about research developments in hepatitis C treatments, in order to help yourself make the best decisions.

    WHAT YOU SHOULD NOT DO

    • Drink alcohol - this could further damage your liver.

    • Take prescribed, over-the-counter medications or herbal supplements without your doctor's knowledge.

    • Share personal items such as toothbrushes, razors, nail clippers or syringes. 

    •Donate blood, plasma, organs, sperm or body tissue.

    If you are not a carrier, the only way to avoid being infected is not to come into contact with the blood or body fluids of an infected person, especially through open wounds, shared needles or sexual contact.

    Dr Cheah Yee Lee

Hepatitis C is a serious global health problem that has infected about 3 per cent of the world's population - about 130 million to 150 million people. There are several sub-types of the virus, and their prevalence differs in different parts of the world.

One major genotype is especially common in South-east Asian countries, such as Singapore, Indonesia and the Philippines. It can be detected by a blood test, and the results determine the anti- viral regimen for treatment.

This highly contagious disease is often spread by contact with the blood of an infected person, such as through open wounds and sores, blood transfusions, and sharing of syringes.

Occasionally, it may be passed through unprotected sex where there is an exchange of bodily fluids like semen and vaginal fluid.

But hepatitis C is unlikely to spread via saliva. Also, only about six out of every 100 babies born to mothers with the virus will be infected.

SIGNS AND SYMPTOMS

Symptoms of hepatitis C can appear 15 to 150 days - known as the incubation period - after one gets infected with the virus.

Common symptoms include jaundice, fatigue, nausea, itchy skin and swollen ankles. In severe cases, symptoms usually include liver failure and the person would need to be hospitalised.

Symptoms of acute infection may be mild and non-specific in most infected people, but about 85 per cent of hepatitis C patients will develop chronic hepatitis. For the rest of the patients, the infection will clear up within a few months.

Hepatitis C can be diagnosed through a specialised blood test. As this test is not part of most check-up routines, the infection can remain in the liver for a long time and remain undetected until more severe symptoms surface.

At-risk individuals - such as drug users who share needles - should ask their doctors to run blood tests to check for hepatitis C during regular check-ups.

Some discover that they are infected after donating blood, as all blood donations are thoroughly screened for hepatitis C.

Yet others learn that they have it only after undergoing blood tests for other medical problems.

One significant indicator of liver infection or damage, which may surface in other medical tests, is an abnormal level of liver enzymes.

Treatment methods for chronic hepatitis C are evolving rapidly, with excellent results for many patients. Most forms of medication now involve tablets taken orally over 12 to 24 weeks, with minimal side effects, compared to older methods such as interferon injections.

While a vaccine for hepatitis C has yet to be developed, there is a more than 90 per cent chance of being cured of the disease with early detection and appropriate treatment.

  • Dr Cheah Yee Lee is a liver transplant and hepatobiliary and pancreas surgeon at the Asian American Liver Centre, Gleneagles Hospital. She treats patients with liver failure and benign and malignant conditions of the liver, pancreas and bile ducts.
A version of this article appeared in the print edition of The Straits Times on October 13, 2015, with the headline 'New hepatitis C treatments have excellent outcomes'. Print Edition | Subscribe