When hepatitis strikes

liver411

March 14, 2002 When hepatitis strikes Medical briefing by Dr Thomas Stuttaford In those far-off unreformed days when doctors made rude and pejorative remarks about patients on their medical notes, the shorthand TATT was so widely known that it became unusable. These patients, dreaded by every doctor, were tatties, whose complaint was that they were tired all the time (TATT). Nobody doubts that these patients are abnormally tired, and less well endowed with vitality than most people of their age, but the question their complaint always raises is whether the tiredness is psychosomatic or there is a physical cause. Extreme tiredness without any other obvious signs or symptoms can signal a host of troubles, including cancer of the stomach, caecum or other parts of the colon, Parkinson’s disease, congestive heart failure or coronary heart disease. The nagging worry they implant in the doctor is that even if the patient could be shown to have been perfectly fit the last time they came to discuss their lethargy, how can anyone be certain that by now they have not developed some specific disease? A recent Woman’s Hour programme emphasised that doctors now have another possible explanation, which needs to be excluded when a patient complains of constant tiredness. They might have hepatitis C, in which case they will need treatment. People who were young and caught up in the revolutionary years of the Sixties, Seventies and Eighties may have experimented with intravenous drugs and in all probability indulged in a sex life that would have surprised an earlier generation. The student drugtaker in the Seventies may since have graduated, become a respected chartered accountant — or doctor — and may have no idea why they are suffering headaches, falling asleep over their spread sheets, and once home cannot stay awake to watch the news or summon up the energy to make love. It is too easy to ascribe their symptoms to mid-life crisis or the female, or male, menopause. If hepatitis C is not eliminated from the body, patients may develop cirrhosis, which can lead to chronic liver failure and, in a proportion of patients, cancer of the liver. Fifty per cent of UK patients infected with hepatitis C are, or have been, intravenous drug users, while another cause is having sex with an infected partner. Transmission seems to occur more readily with homosexuals than heterosexuals; in the UK the rate of prevalence in homosexual men is 2.2 per cent, as opposed to 0.4 per cent in heterosexuals, although there is a higher incidence among prostitutes. Contaminated blood transfusions had been a frequent cause of hepatitis C and was responsible for infecting 76 per cent of patients with haemophilia with the virus. Since all blood and blood products used for transfusion are now screened, transfusions have been virtually eradicated as a cause of infection in this country, but the risk is greater overseas. A survey showed that nearly 20 per cent of blood donors in Egypt had been infected with hepatitis C. In a sizable proportion of patients, the source of the infection is never discovered, and for this reason no one should assume that finding a positive hepatitis C blood test can be equated with uncovering a former drug-taker or Don Juan. The good news is that the treatment for hepatitis C, although not universally successful, is improving by leaps and bounds. A great advance is the introduction of treatments which are more efficient at not only clearing the virus from the blood for a time but permanently eliminating it. Duo therapy using a combination of Pegasys (peginterferon alfa-2A) with Ribavirin (tribavirin) eradicates the hepatitis C virus in 55 per cent of patients and is more efficacious than monotherapy. When there is resistance, it seems to be related to the genotype of the virus. Monotherapy using Pegasys alone has advantages in some patients as it is more free of side-effects than when used in combination with Ribavirin. Results of a trial published in the journal Hepatology showed that patients taking Pegasys as a monotherapy had fewer adverse reactions, such as headache, fatigue, bodily pain and general malaise. than those taking a combination. Their quality of life during treatment was so improved that those who were unable to tolerate the combined drugs would persevere with their potentially lifesaving treatment.