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Viral hepatitis: a deadly but overlooked epidemic

World Hepatitis Day is held on Friday 28 July to promote awareness about this widespread and deadly viral disease.
Viral hepatitis receives very little public attention. Dr. Anja De Weggheleire’s research at the Institute of Tropical Medicine Antwerp (ITM) aims at finding better ways to tackle hepatitis in countries where resources are limited. A project De Weggheleire is piloting in Cambodia holds promise for tens of thousands of patients.

Viral hepatitis causes as many deaths as HIV and TB, yet most people have never heard of it. The disease claims an estimated 1.45 million lives per year, among which nearly 500.000 because of chronic hepatitis C. Around the world there are around 71 million people chronically infected with hepatitis C. Due to similar modes of transmission, infections are higher among people living with HIV.

Despite being a major killer, chronic infection with hepatitis C was, for long, an ignored health problem in low- and middle-income countries, as the available treatment was too complex, costly and had a low success rate.

“Since 2014, direct-acting antivirals are available which cure more people in less time. This well-tolerated oral treatment is a game-changer, but the big question is how to put them in practice in countries with limited resources and health infrastructure. That starts with the challenge to actually find the hepatitis patients, and do so as early as possible,” said Dr. Anja De Weggheleire.  

In the early 2000s, Sihanouk Hospital Center of Hope (SHCH) in Phnom Penh, Cambodia, and ITM Antwerp piloted HIV treatment programmes in Cambodia. These programmes played an instrumental role in fighting the HIV epidemic. ITM and SHCH joined hands again this year, inspired by the scale-up of HIV treatment in Cambodia, for a pilot hepatitis C screening, diagnosis and treatment project integrated in the adult HIV clinic services of SHCH in Phnom Penh.

Thus far, HIV patients in Cambodia were not systematically screened for hepatitis C. De Weggheleire and colleagues screened and tested 3045 HIV patients to find 106 patients (3.5%) with chronic hepatitis C coinfection.

“We saw that patients above 50 years of age, patients with diabetes and those with a family history of liver disease were most affected.  Our study group counted very few injecting drug users. Patients are rather thought to have been exposed to hepatitis C via unsafe medical injections in the past, sometimes as long as 20 years ago.” 

Among the co-infected, about 40% were identified with advanced liver fibrosis and thus in urgent need of treatment, which underlines that hepatitis C screening and treatment programmes urgently need to be scaled up in Cambodia.

In a second phase of the project, the researchers will now evaluate the use of the new direct-acting antivirals, describing the challenges during treatment and the treatment outcomes.

“Based on our experience in piloting HIV care in Cambodia, we hope that this hepatitis C treatment project will contribute to generating awareness and action, as well as the tools for clinicians to make diagnosis and put patients on treatment. Most hepatitis C patients live in low- and middle-income countries; that is where we need to make detection and treatment work,” concluded De Weggheleire.

Dr. Anja De Weggheleire and Dr. An Sokkab from SHCH presented their study results this week at IAS 2017, the 9th conference on HIV science of the International AIDS Society.


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