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Monday, Nov 9, 2009
For the majority of its carriers, the hepatitis C virus is not life threatening. Doctors don't understand why an estimated 20 to 50 percent can rid themselves of HCV -- with antibodies left in many as the virus' sole calling card. They don't understand why it leads to serious complications such as cirrhosis and end-stage liver disease in 20 percent of the patients. To those individuals, this virus can be just as crippling as AIDS, and some wither away to little more than skin and bones. And researchers are not even close to finding a vaccine.
"Is it frustrating?" asks Dr. Robert Purcell. The chief of the hepatitis viruses section at the National Institute of Allergy and Infectious Diseases, Purcell has been traveling to Egypt since 1997 to research the virus. "I have been involved in the development of a vaccine for hepatitis B, hepatitis A, hepatitis E. And all of them are a hell of a lot easier than hepatitis C. You do all the right things and still it doesn't work. Just like HIV."
In the United States, doctors commonly prescribe antivirals for their patients with HCV. The drugs peginterferon and ribavirin, taken over 48 weeks, can help 55 percent of the patients rid themselves of the virus for at least six months after treatment. But the therapy varies in effectiveness from genotype to genotype, and it is so expensive it may not be feasible for a country like Egypt to cover the costs for all of those in need.
Dabbous, of Ain-Shams University, says one of the most trying aspects of his job is witnessing the disease progress in those patients whom he cannot offer much more than unproven vitamins and Chinese herbs, or procedures to allay their pain temporarily. But antivirals -- which are not as effective in the genotype most common in Egypt -- cost $20,000 for a course of treatment. They tend to reach only a small circle of people who can afford to pay or whose insurance covers it. Beyond that, Egyptian officials say that perhaps more will be gained if the money is spent on prevention.
"I think everybody in Egypt knows there's a problem with hepatitis C," says Dr. Mohamed M. Zahran, professor of urology at Cairo University and chairman of health board of the opposition party, Al Wafd. "Their relatives or cousins have it. You can't hide it. [The government] should face the facts by calling for financial aid. We need the help of other countries, like the United States and Europe, to treat our patients."
Dr. Zahran says that Egypt needs the international community's help in controlling this disease. He says there should be assistance to pay for medicine and organ transplants. This would ostensibly reduce both transmission and morbidity rates. But even officials from the World Health Organization contend that it's not that simple. Besides the huge financial cost to a poor country like Egypt, where antivirals might work in about 50 percent of the cases where they can be used, the treatment has severe side effects, such as depression, personality changes, debilitating fatigue, nausea and weight loss.
And there are cultural and spiritual barriers to the effective prevention and treatment of HCV in Egypt. Ignorance about its origins and transmission is rife; fatalism about the chance of contracting it creates recklessness and a dangerous climate of resignation. And strict cultural ideas about transplants mean that survival for the hardest-hit victims is almost impossible, unless the person can travel abroad for the surgery.
Walking through the corridors of the liver unit of a public hospital on the outskirts of Cairo, it's difficult to ignore the men, weak from the virus, sleeping in fetal position. It's equally impossible to deny the virus's impact while sitting by Talaat Hassan's bedside and listening to the toll it's had on his life.
"I am not in contact with my children because of fear of infecting them," says the 54-year-old father of three, his eyes glassy. "I'm isolated in a different room and try to decrease hugging and kissing. I eat alone and live alone while the family is in the rest of the house." As he speaks, a tube drains liquid from his distended belly into a Siwa water bottle. Too much fluid in the abdomen swells the midsection to the curves of a woman nine months pregnant. The drainage helps alleviate the pain for about one week.
Doctors have repeatedly informed Hassan that touching won't transmit hepatitis -- only blood-to-blood contact will -- but the situation at home remains the same. He isolates himself from his loved ones despite the heartbreak that it causes everyone involved.
"Our communities aren't very well educated," says Dr. Soraya A. Sharaf, head of parasitology at the National Liver Institute and vice dean for environmental affairs at the Menoufeya University. "So you need to convey the message that it's blood. They think it's only major procedures that cause it."
Hamdy's cousin, Zayed, who couldn't go to Saudi Arabia, believes he may have contracted HCV from dental surgery, though, like most people, he can't say for sure. "I didn't have any symptoms before the blood test," Zayed says as he sits on a couch, squeezed in between his male cousins. "And I still don't have any."
