In conversation with Dr Jayshri Shah, Consultant- Hepatologist, Gastroenterologist and Therapeutic Endoscopist at Jaslok Hospital and Research centre, who talks about treatments of Hepatitis B, C and HIV.
One of its kind and first in the country, a specialty clinic for Hepatitis B, C and HIV has been recently launched by Mumbai based Jaslok Hospital and Research Centre. The clinic is aimed at treating people infected by these three viruses under one roof. Main aim of the clinic is to raise awareness among people about these diseases which can co-exist in the human body and silently progresses to the complication stage at the age of 30 to 40. The hospital is trying to bridge the gap between sporadic treatments offered by basic family physicians, who do not have huge amount of knowledge about Hepatitis B and C, and a dedicated specialty treatment offered by the specialists. Thus, briefly talking about the nature and symptoms of the viruses, awareness and does and don’ts to be followed for these viruses, Dr Jayshri Shah, Consultant- Hepatologist, Gastroenterologist and Therapeutic Endoscopist at Jaslok Hospital and Research Centre spoke to Wellnessindia.com on the occasion of launching of clinic.
What is the meaning of HHH clinic and what it proposes to do?
The concept of HHH clinic means we will treat people infected with Hepatitis B, Hepatitis C and HIV in one clinic. Many people know that the HIV virus exists, which is very dangerous and can cause aids. But, there is little awareness about Hepatitis B and C, although all the three viruses are spread exactly through the same route and this has always been a cause of worry for me as a lever specialist. The sexual route, blood, blood products, blood transfusion, previous surgeries, needle injuries, tattooing and mother to child transmission are the risk factors for HIV and Hepatitis B and C simultaneously.
What inspired Jaslok Hospital to come up with this specialty clinic?
The purpose of getting a dedicated clinic is because till now Hepatitis B and C has been treated by family doctors and not by the specialists. Patients get thumbs up by these family doctors, so they think they don’t have any symptoms. But, most of the family doctors do not have huge amount of knowledge, because of which there is very scattered service provided for these two viruses. Hence, our dedicated and specialist service aims to address this big gap. Our aim is to eliminate these viruses. The WHO has a goal of eliminating Hepatitis by 2030.
What moved you to devote your time for this clinic?
I have been striving for lever wellness as a concept and it is backed by a story. It was a 39 year old patient who had a routine health check and was completely found normal. In those checkups he had blood check, sonography, ENT, eye check etc and six months later when he was referred to me, he was diagnosed to have Hepatitis B. Also, he had lever cirrhosis and lever cancer and I suggested him a lever transplant to which he got shocked. In the routine health check nobody looks at the lever and the only thing they do in the lever is LFT and sonography so this virus is missed out. He also got his family members three brothers and parents checked and then we found that one of his brother and mother was positive. Thus, such incidents made me feel that somebody has to wake up and beat the wagon for Hepatitis B and C and being a lever specialist this was my passion to tap on silent lever disease.
We are really driven by the number of deaths because of TB and HIV at Jaslok.
Please tell us about the nature of these viruses and symptoms at the complication stage?
All the three viruses are silent, which means there are no symptoms. In the early age Hepatitis B and C virus enters your body without your knowing it and can reach the complicated stage in your 30s and 40s. It silently harms your lever cells and slowly over a number of years infects them until it causes inflammation that is irritation and redness which means scarring in liver cells called lever cirrhosis. Further it can increase the risk of lever cancer if left untreated.
The infected patient vomits blood, gets jaundice, swelling of the feet and tummy, confusion in their mind and loss of memory and this is what brings them to the doctor. If the patients are diagnosed early they can avert all these complications. As far as HIV is concerned even in the early stages it doesn’t produce any symptoms and then it can silently progress to various complications and that is not unique to the liver, but it can affect other organs of the body. Generally the immune system goes for a toss and you start getting various infections.
Can all these viruses co-exist in human body?
Yes they can, around 15 percent of the patients with hepatitis B also have HIV in their blood. About 5-10 percent of the patients with Hepatitis C will have HIV as well. When these viruses co-exist the complication risk is accelerated three times. The complication of lever cirrhosis and lever cancer is faster in somebody with HIV and Hepatitis B versus Hepatitis B alone. Likewise the same complications are more with HIV and Hepatitis C versus Hepatitis C alone. Same way, HIV causes aids so somebody has HIV and Hepatitis B then progression to aids is faster, similar is the case with HIV and Hepatitis C.
What is the span of treatment and how cost effective is it?
Today we have very good drugs for Hepatitis C and we can clear 95 percent virus in the patients with the fix duration of therapy for six months or three months depending on the nature of the infection and severity of the illness. For Hepatitis B also we have very good drugs to reduce the viral load to reduce the risk of complications. The treatment for HIV and Hepatitis B viruses is lifelong commitment unlike short term course of a week or ten days antibiotics for pneumonia.
Generally the cost of the treatment is out of reach for most middle and lower middle class people. When we deal with large number of patients we can come out with some kind of packages whereby we can cut down on the cost of investigations. We have two specialists on board doing a joint clinic where a number of these patients will get the treatment in one clinic.
To what extent masses are aware of these three viruses?
I feel there is not enough awareness on liver health and the concept of liver wellness. Many people out there are at risk of having Hepatitis B and C. Right now we are getting more patients in the decompensate stage. We want to drive awareness that even if one member is found positive in your family then he/she should be immediately brought for a checkup. If you do not have symptoms it doesn’t mean you do not have the virus. So please come and get yourself checked nevertheless and if you are negative then please get the vaccine for Hepatitis B because it’s a vaccine preventable disease. Now all new born children are availed with Hepatitis b vaccine but our generation didn’t get it.
Please throw some light on statistics of people succumbing to these diseases ever year?
Around 1.34 million people die due to Hepatitis B and C worldwide which is much more than the number of people dying because of HIV. Equal number of people dies because of tuberculosis in the world. In India every year around 6 lakh people are dying because of Hepatitis B, 95,000 are dying because of Hepatitis C and about 85,000 are dying because of HIV. Four percent of India’s population that’s 36 mn has chronic Hepatitis B group disease and one percent of the population has Hepatitis C which is 1.2 mn.
According to you what are the does and don’ts the patients should follow?
He/she should never donate his/her blood because it will not be useful. He should definitely inform his family members because they are at risk of acquiring the infection, depending on the nature of relationship, and they should encourage them to have vaccine. He should avoid sharing personal grooming items. He should consult liver specialist to find out the stage of lever damage.