Gaining greater insight into HCV

UTAR Centre for Research on Communicable Diseases (CRCD), in collaboration with Department of Soft Skills Competency (DSSC) of Sungai Long Campus, organised a physical and virtual talk titled “Hepatitis C: The Journey from Discovery to a Cure” on 15 September 2020. The event saw the attendance of about 140 participants.

Dr Chung delivering his talk

Invited to deliver the talk was Dr Chung Yun Chien, a Consultant Hepatologist and Gastroenterologist at Hospital Selayang. In his talk, Dr Chung first provided a general idea on Hepatitis C (HCV). “Hepatitis C Virus is essentially an RNA virus. There are five main types of hepatitis viruses, namely A, B, C, D and E. All the hepatitis diseases are RNA viruses except Hepatitis B, which is a DNA virus. There are other types of RNA virus of Flavivirus such as Dengue, Yellow Fever and Zika Virus. No vaccine is currently available to prevent Hepatitis C, but there is a vaccine for Hepatitis B. It is actually similar to the dengue virus. To date, there is no vaccine to prevent the complication and development of dengue virus,” he said. He added that the issue with the Hepatitis C virus is the heterogeneity of the virus itself, which allows the virus to escape from the host immune system and medications as well as vaccines.

He presented the worldwide distribution of HCV genotypes, saying that HCV genotype three (54.5 per cent) was the most prevalent genotype in Malaysia, followed by genotype one (40 per cent). He also explained what would happen if an individual was exposed to HCV and he pointed out its difference with Hepatitis B (HBV). “Between 2003 and 2017, only about 23,000 Hepatitis C had been notified to the MOH. This is just the tip of the iceberg. There are a lot of people walking around with Hepatitis C without knowing it. It was reported that the incidence of Hepatitis C had increased from 2.65 per 100,000 populations in 2015. Regardless of males or females, slightly more than 50 per cent of the patients were in the younger age group that is between 26 and 45 years old. Most of the reported patients were of Malay ethnicity,” said Dr Chung. He stressed that the figure presented was dependent on how the case was reported.

He also demonstrated the projection of the current and future disease burden of HCV infection in Malaysia and explained the exposure known to be associated with HCV infection such as injecting drug use and sharing needles, blood transfusions before the year 1994 (transplanted from an infected donor), occupational exposure to blood, birth to an HCV-infected mother, and sex with an infected partner. Furthermore, he explained how to determine an individual who has been infected with the HCV virus and who should be screened for HCV. “Hepatitis C can be cured. Treatment should be given to every individual regardless of who they are, where they come from, and the status of their liver disease,” he said.

Dr Chung moved on to a more positive note, in which he spoke about the treatment of HCV, which was the most important part of the talk. He stated that the primary goal of therapy would be to cure HCV for everyone infected. “Those cured of HCV would have their blood show a sustained virologic response (SVG), after 12 weeks of treatment. The cured patients tend to have reduced liver inflammation, improvements in extrahepatic manifestation and liver necroinflammation, regression of hepatic fibrosis and reduced risk of liver cancer, or Hepatocellular Carcinoma (HCC),” said Dr Chung. He also reminded the participants that while everyone with HCV should be treated, there are three categories of people that need to receive prioritised treatment to prevent the spread of the disease. Speaking on this, he added, “There are the highest priority patients, which consist of those in need of an organ transplant, who have advanced fibrosis (F3 to F4) and extra-hepatic manifestations. Then comes the high priority patients, which are patients with fibrosis 2 or more, co-infected with Hepatitis B (HBV) or HIV or with other chronic lung diseases (CLD). Lastly, there are those that have an increased risk of transmission, such as healthcare workers, incarcerated people and patients on hemodialysis.”

Dr Chung presenting his slides

Dr Chung then described the HCV pre-treatment assessment or the assessment of liver fibrosis in patients. He pointed out several techniques to evaluate the prevalence of liver fibrosis; “There is the normal liver ultrasound method and also the liver transient elastography or also known as fibroscan, which is a non-invasive technique that uses both ultrasound and low-frequency elastic waves to quantify liver fibrosis. There is another method called the liver biopsy; this, however, is less often used because it has a high mortality rate,” said Dr Chung. Afterwards, he shared a roadmap of the progress that the medical world has made, in terms of finding a cure for HCV. A noteworthy milestone that he pointed out was during the 2000s, where Pegylated Interferon (PEG-IFN) and Ribavirin were introduced, increasing the cure rate to almost 60 per cent. Similarly, in 2011, the first antivirals, Boceprevir & Telaprevir were combined with PEG-IFN and Ribavirin and it subsequently improved the cure rate to 70 per cent. However, all these medications were ceased after a while, due to the horrible side effects.

From there, he spoke on several other important topics, such as the HCV replication cycle and drug targets in Chronic Hepatitis C (CHC), the potential mechanism of action of Ribavirin in CHC treatment, Direct Acting Antivirals (DAAs) and Europe approved and recommended HCV DAAs. Dr Chung concluded the talk with a few key messages, whereby he mentioned that screening of high-risk individuals is very important and a cure is possible.

An enlightening Q&A session with Dr Chung

CRCD Chairperson Prof Dr Ngeow Yun Fong (right) presenting a token of appreciation to Dr Chung