Political will needed to control liver diseases: Prof Gill
He said, five hundred million people in the world population are exposed to hepatitis, Pakistan being no exception. “In our country there are two types of viral hepatitis, one is short lived and self-limited, hepatitis A & E, which spreads through feco-oral-route. Summer season epidemics of this type of acute hepatitis are very common throughout the developing world. It is because of poor hygienic standards”. Hepatitis C and B, he said, is a blood born disease and usually chronic and has long term consequences.
Professor Gill said, every 12th individual in Pakistani population is suffering from 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 every body, who is suffering from hepatitis B & C”.
Professor Gill said, 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 equipment, and better hygienic standards in barbershops. It is an easily controllable disease, but mild lapse in precautions can lead to very disastrous consequences.
He said, treatment o hepatitis B & C, in the last decade, was 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 close to 20%.To deal with this problem we have a hope with a new protease inhibitor pill called “GS 9797”. In this particular population group the response rate with this particular pill is close to 90%. For Hepatitis B treatment Pegylated interferon injection, tablet Entacavir and Tenofovir is currently available gold standard.
When asked about effectiveness of Prime Minister Programme for Hepatitis C, he said it marks a tremendous progress in the country. “It is good start, but it needs certain refinements”. He pointed out that availability of quality drugs is an issue. Every Hepatitis C patient deserves a best chance of treatment. Every patient should be given once weekly injection (Pegylated Interferon) and Ribavirin therapy. “Quality of injection treatment which is supplied periodically by the Prime Minister programme is questionable”.
If first time treatment in this population is not done rightly, it becomes very difficult to treat them subsequently. He noted that because of poor treatment policy in our country we are dealing with huge patient population who is so to speak “non responders” and “relapsers”. 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. Pakistan’s total budget is insufficient to take care of these end stage liver disease patients and there are no existing transplant facilities in Pakistan. It is very unfortunate despite several half-baked efforts in public and private sector, there is no fool proof liver transplant facility in the whole country. Government needs to take stock of this situation and establish good quality liver transplant center in the country. “what wer need is political will to overcome liver diseases”, Prof. Gill emphasised.
Research Fellow, Dr. Uzma Gill said: “We have a mixed message on World Hepatitis Day from our country standpoint. I think there is a reasonable awareness among doctors and people regarding the cause and spread of disease. But in terms of timely diagnosis and treatment we are not at a level, where we should be. Private-public partnerships in true spirit and sincerity are needed to get rid of this disease and hopefully we will have hepatitis free Pakistan in near future.”