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Eclipse of Hepatitis C

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A hugely positive note with which 2015 is signing off on the medical front is the revolutionary treatment of Hepatitis C that is set to transform the lives of 12 million Indians and several fold more across the world. Around 1-2% of Indians harbour this chronic viral liver infection, most of them unknowingly and many coming to know of it when they have already developed liver cirrhosis or liver cancer. Treatment over the last 3 decades has been either unusually difficult, with weekly injections of interferon, or impossible (due to weakness or low platelets precluding this form of therapy).
Three oral “miracle” drugs have burst into the world’s therapeutic arena, and what could not have been better is that this treatment is now available in India at less than 1% of the international price!
Sofosbuvir is the prime new anti-viral medicine for treating Hepatitis C that was discovered and launched in USA and Europe by Gilead company at the prohibitive cost of US$ 1000 (Rs 60,000) per tablet to be taken daily for 3 to 6 months, amounting to Rs 1 crore for a full course of treatment. It is now available in India for Rs 400 per tablet.
Sofosbuvir needs to be taken with another supportive drug for better results, called Ledipasvir (for genotype 1, 4 or 6) or Daclatasvir (for genotype 2,3) that also reduce treatment duration to just 3 months. Last week, the latter two drugs also became available in India at affordable prices. The total cost of treatment with these oral regimes is approximately Rs 50,000 over 3 months, with a very high (more than 90% chance of cure) and with hardly any side-effects.
The news has been quick to spread across the world where the treatment cost by original international branded medicines is still upwards of Rs 1 crore. This has led to a huge surge of “medical tourism” with plane loads of patients from across the globe, streaming into India to reap the benefit.
Hepatitis C has been painfully difficult and expensive to treat for 20 years with weekly injections of Peg-Interferon along with a weak anti-viral tablet called Ribavirin given for for 6 to 12 months. Almost every patient who has taken this therapy has felt miserable with adverse effects such as fever, weakness, falling blood counts, anemia and depression.
And in addition to the high cost (Rs 1.5 to 3 lac) and several months of ordeal of treatment, relapses have been frequent: the virus often reappearing quickly on stopping treatment. For specialists, meeting such patients who had invested a lifetime’s savings and endured a year’s tribulation but missed achieving a “cure” has been helplessly humbling.
Hepatitis C had its moment of public recognition when the well-endowed silverscreen celebrity Pamela Anderson of Baywatch fame got diagnosed with it. The sensational manner in which she contracted it made it even more popular: she had shared the needle for a skin tattoo with her boyfriend, Tommy Lee, who had carried the infection. The gossipy tale went further to her litigating against him for concealing the information, but as often happens there, they finally united by wedlock!
All this is soon poised to become history as treatment becomes simple and easy.

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