Muhammad Arif Nadeem, Tariq Waseem, Abdul Malik Sheikh, Nasrullah Grumman, Khadija Irfan, Syed S Hasnain.
Hepatitis C Virus: An alarmingly increasing cause of Liver Cirrhosis in Pakistan.
Pak J Gastroenterol Jan ;16(1):3-8.

Cirrhosis of liver is a frequent cause of admission in our hospitals. With availability of serological methods for detecting Hepatitis C virus (HCV), increasingly patients with cirrhosis are found to have it. At least 50% of infected patients go on to develop chronic liver disease. Cirrhosis develops in about 10-20% within 5-30 years and of these patients, about 15% will finally develop hepatocellular carcinoma. We conducted a study to document the presence of liver cirrhosis due to HCV (an alarming situation) in Mayo Hospital, Lahore. One hundred patients of the liver cirrhosis presenting between April 1998 to March 2000 were included in this study. Screening for viral markers for hepatitis B and C was done, including HBsAg by ELISA method and anti-HCV antibodies test by third generation ELISA. Liver biopsies were also done in patients having no contraindications. Sixty-eight patients (68%) were male and 32 (32%) were female. Majority of patients (38%) were in age range of 51-60 years. Maximum patients i.e. 55 (36 males, 19 females) were positive for antibodies against HCV, the next was HBs Ag positive (23%), only 9% were positive for both and in rest of 13% patients the etiology remained undermined. Major presentations were ascites (76%), jaundice (41%), hepatic encephalopathy (38%), upper gastrointestinal bleed (42%) and fever 24%. Coagulopathy was present in 75% patients. Liver biopsies were carried out in only 10% patients, 1 (10%) patient had malignant changes in liver. There was co-existing chronic hepatitis in 7 (70%) cases along with cirrhotic changes. In 40% patients, mode of infection remained undetected. Twenty-one patients, apparently acquired the infection through needle stick, sexual transmission accounted for 11% cases, operations under improper conditions 7% cases and blood transfusion was the probable cause in 4% patients. We conclude that a multidisciplinary approach for prevention and control of ever increasing HCV infection must be adopted like use of disposable syringes, prohibiting their recycling, sale of injection packs containing disposable syringes and to make the public awareness through the mass media about its drastic complications, and possible modes of its transmission e.g. use of un-sterilized instruments by barbers and for ear piercing.

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