WHEN HEPATITIS STRIKES

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 =E2=80=94 or doctor =E2=80=94 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.