Sunday, May 08, 2016

Hepatitis C infections in the hospitalized patients requiring the interventions – Concern, attitude and care of the health care workers providing the services, How can we address them?



It is estimated that nearly 100,000 people die annually in India from HCV infection and co-morbidities. Around 25% of 18 million HCV patients in India are infected by Hepatitis-C genotype 1 virus. This has become a concern in many hospitals, health care workers and more so in dialysis centers, trauma care centers and intensive care units, who frequently deal with blood and blood products during the course of the treatments.

Source of Hepatitis C infection
This is a complex issue observed in the state run hospitals with limited resources and at the same time the risks of operating on such patients with chronic hepatitis C infection can’t be ruled and one needs to organize themselves for these special situations with special provisions and protection measures.
“Who would like to get exposed to the risk of acquiring hepatitis C infection while operating on patients with chronic hepatitis C infections in our elective operation theaters?”  Said an anesthetist, defending his stand of cancelling an operation in a government run tertiary care hospital. The patient and the surgeon were left with no other option. The patient was asked to choose another hospital which can take up such operations. The fear of Hepatitis C infection, is significant due to the lack of availability of appropriate and affordable treatment within reach of the hospitals. Similar situation was there in the past for the patients infected with HIV.

This is a complex issue observed in the state run hospitals with limited resources and at the same time the risks of operating on such patients with chronic hepatitis C infection can’t be ruled and one needs to organize themselves for these special situations with special provisions and protection measures.
 
In the recent past the hope of curing hepatitis C infection is on the cards in many countries with introduction of the new drug treatments. Harvoni, the fixed-dose combination of ledipasvir-sofosbuvir of 90mg and 400mg, respectively, is an improved version of Gilead’s Hepatitis-C drug Sovaldi or sofosbuvir, seems to be playing a major role in the coming years. Biocon will be selling the generic Harvoni under brand name CIMIVIR-L. The potential market size for these drugs could be Rs.500 crore or even Rs. 1,000 crores in the foreseeable future. This type of treatment would cost Rs.63 lakhs in USA today for one individual. But the Indian company is determined to supply this medicine at an affordable price (< Rs. 70,000). In the absence of vaccination for the Hepatitis C infection, there should be provision for the supply of these medicines with the help of insurance to the health care workers. Hospital management should take a lead and assure the health care workers that there is support for them in any exposed gets hepatitis C infection during their service.


Pinjala R K
 

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