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Journalism of Courage
A 35-year-old walked into the outpatient department (OPD) of Apollo, Delhi, with a simple complaint: Persistent tiredness that had lasted for nearly three months. He had no other significant symptoms, no jaundice, no abdominal pain and no weight loss. As part of the routine workup, Dr Sudeep Khanna, gastroenterologist and GI medicine specialist, ordered an extensive panel of blood tests, including haemoglobin levels, kidney function, liver function, thyroid profile, blood sugar, vitamin levels and even an abdominal ultrasound. Everything appeared normal, except one clue.
His AST and ALT, enzymes that reflect liver health, were mildly elevated (around 50 U/L, with the normal being less than 40). “The ultrasound showed a normal-looking liver with no masses or structural abnormalities. But in experienced hands, these minor anomalies were enough to raise suspicion. Recognising that subtle liver enzyme elevation can be a marker of viral hepatitis, I ordered two more tests: Hepatitis B surface antigen and anti-HCV antibodies. While the Hepatitis B test came back negative, the anti-HCV test was positive, suggesting that he had been exposed to the Hepatitis C virus,” says Dr Khanna.
To confirm active infection, he measured the HCV RNA in his blood. The results were clear: He had 100,500 IU/mL of the virus, well above the normal undetectable range of <25 IU/mL. He had chronic Hepatitis C, but thankfully, it had been caught early.
The patient was started on a 12-week course of direct-acting antivirals (DAAs), a combination of two oral drugs specifically designed to eliminate the Hepatitis C virus. “Unlike older treatments which involved interferon and carried multiple side effects, DAAs are now highly effective, safer and easier to administer. Just one month into treatment, the fatigue that had brought him to the hospital disappeared completely, the first sign that the medication was working. He completed his full three-month course without any complications,” says Dr Khanna. A few weeks after completing therapy, he was retested for HCV RNA. This time, the result was undetectable. He was declared cured.
Hepatitis C is often called a silent disease, not because it is rare but because it hides in plain sight. Globally, over 58 million people live with chronic Hepatitis C virus (HCV) infection, many unaware of its presence until it causes significant liver damage.
It often has no clear symptoms. Fatigue may be the only sign and even that is often overlooked or misattributed. Routine health checks may not catch it. Liver enzymes can be only mildly elevated and ultrasounds may appear normal even in active disease. “Testing for HCV should be considered in any patient with unexplained liver enzyme elevation, even in the absence of classic symptoms. Early diagnosis leads to easy treatment. With the availability of DAAs, patients no longer have to suffer or fear lifelong liver damage, provided the virus is caught in time,” says Dr Khanna.
One of the most widespread and deeply rooted misconceptions around hepatitis is that it comes from alcohol consumption. “Hepatitis B and C are viruses transmitted by blood and other body fluids, and if one infects oneself chronically, then there is a possibility of liver damage, cirrhosis, or even liver cancer, no matter one’s lifestyle discipline,” says Dr Sandeep M S, Gastroenterology/GI Medicine Specialist, Apollo Hospitals, Bengaluru.
Hepatitis B or C virus will definitely not be passed through the sharing of utensils, hugging or eating with an affected person. Also, adults aren’t the only ones affected by hepatitis, children and neonates are also vulnerable. A baby that comes from a mother who is infected with hepatitis B is likely to catch the disease if preventive actions have not been implemented.
Hepatitis C does not have a vaccine like hepatitis B but new treatments can cure hepatitis C infections.
