Fighting Hepatitis in Cambodia: Hep C 101

What is hepatitis C? How do people catch it, and what does it mean when you have it? Theresa is a doctor working at the MSF hepatitic C clinic in Phnom Penh, and she blogs about the illness she and the team are dedicating their days to fighting... 

A lot of our patients have known they were infected with chronic hepatitis C for a long time, sometimes for decades. For all of these years, they have assumed there would be no chance of cure, and have wondered how many years of their lives would be cut short by the disease. This is why it’s a happy job to work at MSF’s hepatitis C clinic. We give out a lot of good news and we deliver hope.
A woman smiles next to two enormous mangoes in the MSF hepatitis C clinic in Phnom Penh
This woman is starting treatment with direct-acting antivirals (DAA) today. Her donation? Two home-grown mangos. Photo: Theresa Chan
Although many people have a long knowledge about their own infection, they often don’t know much about the basics of hepatitis C. So a big part of our job is to fill in knowledge gaps as the patients come for screening and treatment.
This is what I tell them.
Hepatitis means inflammation of the liver. There are many causes of hepatitis, including alcohol abuse and the effects of certain medicines, but worldwide, many severe cases of hepatitis are caused by infections. Hepatitis A, B, C, D and E are all caused by viral infections. Despite this, they are all slightly different from each other, and that is why the approach to treatment and prevention is different for each type.
Hepatitis C is transmitted from blood exposure. For this reason, people who are exposed to blood via high-risk sexual practices, unsafe healthcare procedures, healthcare employment, or childbirth are at risk of getting infected. In Cambodia, we estimate that most of our patients were infected during many years of civil unrest, when the healthcare system collapsed. This is an example of the kind of long-term health consequences that happens during periods of sociopolitical insecurity. 

In Cambodia, we estimate that most of our patients were infected during many years of civil unrest, when the healthcare system collapsed

In general, when people get infected with hepatitis C, they have few symptoms. Some people may experience a viral-like illness, but this is actually unusual. Although some people will resolve the infection without treatment, more than half will progress to chronic infection. This is important to understand, because hepatitis C causes most of its damage over years and decades following infection, and it does so almost silently.
Most people with chronic hepatitis C are diagnosed during risk-factor based screening, or because they have abnormal liver enzymes on routine blood tests, and not because they feel sick. During chronic infection, people feel perfectly fine, despite the fact that the hepatitis creates an inflammatory environment that promotes fibrosis, or scarring, of the liver. Some people will only develop mild fibrosis, and are unlikely to progress to the most severe complications of hepatitis C. Unfortunately, a subset of people will develop severe fibrosis, and these are the people who will develop the dreaded complications of hepatitis C: cirrhosis and hepatocellular carcinoma (liver cancer).

Hepatitis C causes most of its damage over years and decades following infection, and it does so almost silently

Cirrhosis describes a condition in which the liver is almost completely replaced by scar tissue. It can’t perform its usual functions, and blood can’t flow easily through the veins that pass through the liver, so people develop symptoms at this stage. These include ascites, an abnormal collection of fluid in the abdomen; easy bleeding from abnormally enlarged veins in the digestive tract; and confusion or encephalopathy from an accumulation of metabolic toxins usually cleared by the liver. We see many patients with cirrhosis at MSF’s hepatitis C clinic, in the hope that treating them will stop the progress of their symptoms and improve their quality of life.
Unfortunately, we also see a lot of patients with liver cancer. This type of cancer is strongly associated with chronic hepatitis, especially hepatitis B and C. Sadly, DAAs will not help patients with liver cancer. Most of the bad news we have to break in the clinic is to cancer patients, who don’t have many treatment options in Cambodia.
If you would like to know more about hepatitis in general, this video provides a great overview:

Killer diseases - Hepatitis from MSF Access Campaign on Vimeo.