The lethal 'C'

Gynecologists have made it necessary for all expecting mothers to get themselves tested for Hepatitis C. 

According to National Programme for Control and Prevention of Hepatitis (NPCPH), there are about 5 to 6 per cent of hepatitis C patients. But the number of those with hepatitis C could be significantly higher if the entire Pakistani population were screened for the disease. Karachi-based general physician Dr Abu Talib explains about the disease.

"Hepatitis C is an infectious disease that affects the liver. It stops it from functioning properly and leads to swelling of the liver. The infection is often asymptomatic, but once established, chronic infection can progress to scarring of the liver (fibrosis), and advanced scarring (cirrhosis) which is generally apparent after many years. 

Every human being requires a healthy liver as it fights against infections and stops bleeding. It also removes drugs and other poisons from your blood, storing energy for whenever it is needed." 

Who is at risk?

According to Dr. Abu Talib, hepatitis C infection is caused due to the hepatitis C virus (HCV). People at risk may include:

* Long-term kidney dialysis

* Regular or direct contact with blood at work (for instance, if you are working as a health care worker)

* Have unprotected sexual contact with a person who has hepatitis C 

* Share a needle with someone who has hepatitis C

* Receive blood or organs from a donor who has hepatitis C

* Share personal items such as toothbrushes and razors with someone who has hepatitis C (less common)

* Born to hepatitis C infected mothers (this occurs in about 1 out of 20 babies born to mothers with HCV).

Symptoms:

Some of the common symptoms of the disease include abdominal pain (right upper abdomen) and swelling (due to fluid called ascites); bleeding from the oesophagus or stomach (due to dilated veins in the oesophagus or stomach called varices); dark urine;

fatigue; fever; jaundice; loss of appetite and nausea. 

Women and hepatitis C:

Hepatitis C does not spread through casual contact such as sneezing, coughing, hugging, or sharing drinking glasses. She suggests that women who have undergone a C-section or some other sort of surgery that requires blood transfusion should be tested for HCV, as blood transfusion is one of the main causes why this disease spreads. Many expectant women who are diagnosed positive for HCV have to wait till the baby is born, as the drugs are supposed to harm the foetus. Transmitting the virus to their babies during pregnancy or birth is one of their biggest concerns. 

Studies consistently show that the rate of transmission is low, about 5 per cent or 1 in 20 pregnancies; transmission only occurs when the women are diagnosed HCV RNA positive. Women who have chronic hepatitis C (that is, they still have HCV after six months of birth) do not tend to develop liver cirrhosis (scarring), liver cancer, or liver failure as rapidly as men. The female hormone oestrogen is said to protect women from liver damage. But the protective effect of oestrogen may diminish after menopause, as women's bodies produce fewer hormones.

Although HCV has been detected in breast milk in some studies, there is no indication that breastfeeding transmits the virus. Most experts do not discourage HCV-positive women from breastfeeding. But women who have cracked or bleeding nipples should be careful and consult the physician before breastfeeding. HCV is not transmitted from mothers to children through normal household contact. 

Ribavirin (medicine for hepatitis C treatment) is known to cause miscarriages and birth defects, so women should not use this drug during pregnancy. Most doctors also recommend that interferon (another hepatitis drug) should not be taken during pregnancy because of its effects on the foetus. 

Don'ts for people with hepatitis C:

Be careful not to take vitamins, nutritional supplements, or new over-the-counter medications without first discussing it with your health care provider. Try to avoid any substances that are toxic and affects the liver (hepatotoxic). Even a moderate amount of toxic substance speeds up the progression of hepatitis C, and reduces the effectiveness of the treatment.