03 January 2004	Saturday	10 Ziqa'ad 1424

KARACHI, Jan 2: Like that of Hepatitis B, the prevalence of Hepatitis C Virus (HCV) is increasing steadily among the Pakistanis. Yet there is little awareness among them of the risk factors involved, a series of studies has shown.

The studies - collated by Adeel A. Butt MD, a US-based Pakistani doctor - reveal that 80 per cent of the people have never heard of viral hepatitis. And more than 30 per cent are unaware of HIV.

Moreover, about half of the Pakistanis are not willing to spend extra on procuring safe blood for transfusion. And alarmingly, more than half think that general weakness is reason enough to go for blood transfusion.

This only goes to show that a large number of people are vulnerable to transfusion of blood tainted not only with HCV, Hepatitis B but also HIV or AIDS.

In an study, involving 203 patients, more than 40 per cent of the Pakistanis favoured injections over oral medication, even if the two are equally efficacious. It was also observed during this study that non-sterile or previously used syringes are used in more than 90 per cent of the injections administered.

A study carried out in Rawalpindi and Islamabad showed that injections and facial and armpit shaves by barbers represent considerable risk vis-a-vis HCV. Another survey showed that blood transfusion (4 to 6 per cent) and surgery (12 to 27 per cent) can result in transmission of HCV.

Yet another study, undertaken at the Sheikh Zayed Hospital, identified the following risk factors: dental procedures, 40 per cent; injections, 17 per cent; surgical procedures, 17 per cent; family history, 9 per cent; blood transfusions, 7 per cent; and, tattoos, 5 per cent. Tattoos included ear and nose piercing.

According to Dr Butt, HCV is five times more prevalent than HIV. In the United States alone, there are 4 million infected persons. And between 8,000 and 10,000 deaths every year can be linked to HCV.

The World Health Organization says that Africa has 31.9 million people who are infected. Eastern Mediterranean has 21.3 million and South-East Asia has 32.3 million such persons.

The total number of infected people in the world stands at 169.7 million. The total population being 5,811 million, the prevalence rate is 3 per cent. A study involving 103,000 blood donors, carried out between 1996 and 2000, found out that 4 per cent were HCV positive, another 3.3 per cent had HBsAg. This serves to underscore the need for a system under which every blood bag is screened for HCV, HBsAg and also HIV.

Yet another survey, carried out in Gujranwala and Lahore, revealed that as many as 15.9 per cent to 23.8 per cent people tested positive. Most people testing positive for HCV were more than 20 years old.

Dr Butt - Assistant Professor of Medicine and Infectious Diseases at the University of Pittsburgh School of Medicine - is of the view that this study, based on responses from about 500 people in Lahore and 2,000 persons in Gujranwala, gives rather inflated figures.

He points out that the respondents in the study were people who had reasons to contact the researchers, after watching their various ads. He, in other words, implies that many of the people who took part in the survey were possible patients.

In a study, involving patients of chronic liver disease in Hazara, 41 per cent tested positive for HCV antibody. The prevalence was 42 per cent in males and 38 per cent in females.

Among the known patients of liver disease at the Combined Military Hospital, Rawalpindi, 35 per cent tested positive for HCV and HBcAb. Seven per cent were positive for HCV and HBsAg both. Disease is more severe in patients with co-infection.

Dr Butt says treatment is available for HCV. However, the treatment is quite costly. Therefore, the best option is prevention. No vaccine is likely to be made available for the next ten years, he says.