Political will, resolve needed to control liver diseases:Gill

All over the world, the 19th of May is World Hepatitis Day. This is to make awareness among the people about hepatitis, its spread, prevention and treatment. Following are the comments of Prof. Dr. Muzzaffar Lateef Gill.

Five hundred million people in the world population has exposure to hepatitis, Pakistan is no exception. In our country there are two types of viral hepatitis, one is short lived and self-limited, it is because of hepatitis A & E, which spread through feco-oral-route. Summer season epidemic of this type of acute hepatitis are very common throughout the developing world. It is because of poor hygienic standards. Hepatitis C and B is a blood bond disease and usually chronic and has long term consequences.

Every 12th individual in Pakistani population is suffering form hepatitis B & C. We as a nation need two-prong approach, one is to prevent the spread of the disease and the second approach is to have foolproof treatment for everybody, who is suffering from hepatitis B& C. For prevention purposes, there should be universal vaccination for hepatitis B, which is almost in progress everywhere in Pakistan. The most important aspect of prevention is screening of blood products, sterilized equipments, and better hygienic standards in barbershops. It is an easily controllable disease, but mild lapse in precautions can lead to very disastrous consequences.

Treatment of hepatitis B & C in the last decade has been revolutionized. Hepatitis C sub type, which exists in Pakistan, is close to 90%, curable if appropriate combination at appropriate time is used. Worldwide weekly injection along with ribavirin is the gold standard treatment and duration is 24 weeks. New challenge we are facing now is the relapse/recurrence of hepatitis C after the completion of Pegylated interferon.This is very alarming situation and the incidence of this problem is 10 to 15%. To deal with this problem we have a hope with consensus interferon (Infergen) .In this particular population group the response rate with this particular injection is close to 90% Regarding Hepatitis B treatment Pegylated interferon injection or tablet Entacavir is the current available gold standard

Prime minister program for hepatitis C is a tremendous progress in the country and it is good start, but it needs certain refinements, availability of quality drugs is an issue and there are some special categories of patients, who instead of getting three injections per

week, which is second choice, should be given once weekly injection (Pegylated Interferon).Quality of injection treatment which was supplied periodically by the prime minister programme was questionable. If first time treatment in this population is not done rightly. It becomes very difficult to treat them subsequently. In our country because of poor treatment policy we are dealing with huge patient population who are so to speak “non responders” and “relapsres”. The consequences of treatment failure are huge. The patient develops advanced stage disease, i.e. cirrhosis then patient starts bleeding and belly swells up, then the only option is liver transplant. Whole Pakistani budget is insufficient to take care of these endstage liver disease patients and there are no existing transplant facilities in Pakistan.

In summary, we have a mixed message on World Hepatitis Day from our country standpoint. I think there is a reasonable awareness among doctors and public regarding the cause, spread of disease. But timely diagnosis and treatment is not, where we should be. Both private and public partnerships in true spirits and sincerity are needed to get rid of this disease and hopefully we will have hepatitis free Pakistan in near future.