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Logo of Phnom Penh Post newspaper Phnom Penh Post - Curing the incurable becomes a reality

Curing the incurable becomes a reality

“You’re negative,” I said and handed her the results. The smile turns to relief, then elation.
Years of living with the virus, six months of difficult treatment, then a six-month wait to see if the virus was completely eradicated.

She strode out of the consultation room and down the corridor clutching the vital result, with a spring in her step and renewed vitality. Along with the hepatitis C virus, the disease was now gone, as was the stigma. Normal life once again.

We live in world full of viruses – some well known, others not, still others awaiting discovery. They range from the irritating common cold to the devastating sociocultural phenomenon that is the human immuno-deficiency virus, or HIV.

The elusive nature of viruses have long defied medical science, none more so than viral hepatitis, which affects nearly half of the world’s
population.

More than 500 million people are currently infected with some form of hepatitis.

Compare that with the 42 million worldwide now living with HIV – long considered a more lethal epidemic – and one can begin to grasp the scope and impact of hepatitis.

In addition to causing liver disease, hepatitis is also the most common cause of liver cancer. The virus falls into a series of alphabetical categories, with hepatitis A and B the most common, and treatable, forms.

Hepatitis C was discovered in 1989, and had been referred to prior to its identification simply as non-A, non-B hepatitis.

It is the most elusive and often deadly form of hepatitis, afflicting nearly 170 million people globally and claiming the lives of half a million people each year.

And until the late 1990s, there was no real hope of a cure. Progress has been steady since that time, and in 2010 we can almost refer to hepatitis C as a curable disease.

Just last year, the medical community watched transfixed as the latest drug trials for hepatitis C reported a 75 percent cure rate for a disease that has for so long defied treatment.

Hepatitis C, or HCV, behaves much like HIV by constantly changing to evade attack by the body’s immune system.

Interestingly, the body can clear the virus itself in about 25 percent of cases. This success rate depends on a number of factors, in particular a strong immune system. And unfortunately, up to 75 percent of those exposed to HCV see initial infection become chronic.

The time lag between initial infection and liver failure can be up to 25 years, so HCV remains largely a silent epidemic.

Most infections occur in the developing world, whereas treatment – often costing upwards of US$15,000 or more – is available mostly to people living in the developed world.

Fortunately, treatment for hepatitis C is available in Phnom Penh, and a number of people have already been cured. But the cost puts treatment out of reach for the more than half a million Cambodians living with the virus.

Successful trials have been achieved with a triple regimen of pegylated interferon, which boosts the immune system, and the antiviral drugs ribavirin and telaprevir. This cocktail saw a cure rate of 75 percent in trials reported recently in the New England Journal of Medicine.

A new antiviral drug, boceprevir, has also produced similar results.

Key to successful treatment is to attack the virus at multiple points in its life cycle in order to give the body’s immune system a better chance of destroying it.

The battle to eradicate hepatitis C is fierce, and it has attracted considerable investment by the pharmaceutical sector.

Not surprising, as 4 million Americans and a similar number of Europeans – as well as millions across developing Asia – are potential candidates for treatment.

Medical researchers are looking for the holy grail, a combination of tablets much like treatment for HIV, as well as a shortened treatment cycle, dropping from the current six to 12 months down to three or less.

Cost remains a crucial factor if the developing world is to benefit from recent and forthcoming breakthroughs.

However, greater awareness of the threat of hepatitis C, and now its potential cure, is vital, and community activists have begun the difficult task of spreading the word.

So the once incurable hepatitis C virus has become less elusive and in some cases curable, but like so many other things it depends on where and under what circumstances you live.

In the end, it will be the strength of the community voice to spur continued research and access to treatment that will ultimately help confine hepatitis C to history and save countless lives in the process.

Normal life once again.
________________________________
Dr Nick Walsh is chief medical officer
at International SOS in Phnom Penh.

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