Hepatitis C, A Mega Menace: A Pakistani Perspective

About 10 million Pakistani population is infected with Hepatitis C virus (HCV). The prevalence is even more pronounced among high risk population. The commonest mode of transmission is the use of injections, unsterilized needles and contaminated instruments. Combination of standard interferon and ribavirin is still the first line therapy with sustained viral response (SVR) up to 40-50%. Pool of relapsers and nonresponders is increasing in Pakistan and needs treatment with pegylated interferon plus ribavirin (peg IFN/RIB). Pegylated interferon has limited use due to being costly. Efficacy of pegylated interferon in genotype 3 is still debatable. HCV related end stage liver disease and hepatocellular carcinoma (HCC) is a major cause of morbidity and mortality in health care settings of Pakistan causing exponential burden on financial health care resources. Conflicting Interest: None Declared This article has been peer reviewed. Article Submitted on: 12 th January 2012 Article Accepted on: 15 th March 2012 Funding Sources: None declared Correspondence to: Muhammad Bilal Address: Army Medical College, Rawalpindi Email: [email protected] om INTRODUCTION The World Health Organization (WHO) had estimated that 180 million people are infected with Hepatitis C virus in 2009. Three to four million people get newly infected each year. Two third of these newly infected cases develop chronic liver disease [1]. HCV infection is responsible for 60-70% of all liver cancer cases and is the commonest cause of liver transplant all over the worldwide [1]. Liver cirrhosis is the 18 th commonest cause of mortality [2]. HCV related liver cancer is the 8 th common cancer worldwide. HCV infection prevalence varies from country to country. The global prevalence of HCV infection is 2.2 to 3% [3]. In the US and European countries, prevalence is 1.6 to 1.8% and 1 to 2.3%, respectively [4]. Pakistan is the 6 th most populous country in the world with an estimated population of 16,094,3000. Prevalence of HCV infection reported in various studies by the Pakistani authors ranges from 2.2-14% [5]. Accordingly, approximately 10 million people in Pakistan are infected with HCV [6]. Within Pakistan, the HCV prevalence rate varies between the four provinces; prevalence rate reported in Punjab is 6.7%, in Sindh 5%, in Baluchistan 1.5%, and in Khyber Pakhtunkhwa 1.1% . The prevalence of the HCV antibody positivity high risk groups (such as patients on chronic hemodialysis, health care workers, and thalassemia or hemophilia patients) is 38% to 55%. The comparison of prevalence and antiHCV positive cases with neighboring countries of Pakistan is demonstrated in Table 1. RISK FACTORS FOR TRANSMISSION Injudicious use of injections had been reported as a major risk factor for HCV infection in Pakistan [9]. Luby et al reported in their study from Hafizabad, Punjab that HCV infected patients had received five or more injections in the past 10 years compared to non-infected persons [10]. In another study, Pasha et al reported that the household members who had more than 4 injections per year were 11.9 times more likely to get HCV infection than others [11]. Shazi L et al in 2006 reported injection use as a major mode of transmission of Hepatitis C [12]. Injection drug users (IDUs) were even at high