Chronic Liver disease – a public health priority
Liver disease constitutes a group of conditions that can be
caused due to infections, inherited, obesity or alcohol abuse. Liver cirrhosis
is a commonly used term that refers to the scarring of the liver over a course
of time. As more scarred tissue replaces healthy tissue, it impacts the normal
functioning of the liver leading to liver failure and liver cancer.
Global prevalence of
liver disease
Liver disease is among the leading causes accounting for approximately 2 mn
deaths per year worldwide. 50% of these are caused due to complications of
cirrhosis while viral hepatitis accounts for the rest 50%. Cirrhosis is the 11th most common
cause of death globally. The global prevalence of viral hepatitis too remains
high.*
Burden in India
According to the WHO, liver diseases are considered to be the tenth most
common cause of mortality in the country. A staggering 10 lakh Indians are
diagnosed with liver cirrhosis every year. In fact, one in five Indians is
likely to suffer from liver disease.**
While progress has been made in understanding the causes of
liver disease and developing treatments, significant challenges still exist. To
start with, the progressive adoption of sedentary habits, unhealthy food
habits, increase in alcohol consumption have created grounds for a spectrum of
liver diseases in India. An upward moving BMI and diabetes burden are leading
to a rise in NAFLD.
Tropical infections such as dengue, malaria, leptospirosis,
and TB with hepatic involvement are more prevalent in India and can cause liver
damage.
Viral causative factors remain a big concern. Despite the
advances made in the country towards hygiene practices and sewage treatment,
Hepatitis E is still the most common cause of acute liver failure in India. Hepatitis
E‐induced acute liver failure is associated with a very high mortality in
pregnant women, and this is somewhat unique to India.
Hepatitis B and C which are transmitted through infected
blood, are the most common types to be detected in the country.
The National Viral
Hepatitis Control Program (NVHCP) 2018 launched by the Government of India, is
an integrated approach for prevention and control of viral hepatitis, with a
view to provide free of charge screening, diagnosis, treatment and counselling
services to all, and specially to people belonging to high-risk groups. Further, a national NAFLD control program has
just been launched in 2021 with activities that integrate liver disease control
more broadly into any other non-communicable diseases control program.
Different causes of
liver disease
A host of causes can lead to liver disease. Enlisted below are few main
ones:
Viral hepatitis
which can lead to severe liver disease including hepatocellular cancer refers
to the inflammation of the liver caused by the different types of hepatitis
virus. A cause of major healthcare burden in India, viral hepatitis is equated
to other big communicable diseases such as HIV/AIDS, malaria and TB.
Alcoholic fatty liver
disease is the earliest stage of cirrhosis caused as the name suggests, due
to alcohol abuse.
Non-alcoholic Fatty
Liver disease (NAFLD) is a term for a range of conditions caused by the
build-up of extra fat in the liver cells. NAFLD is also associated with an
increased risk of serious health problems such as diabetes, high BP and kidney
disease.
Testing strategies
The prevalence of HBV in the general population is showing a decline over
time. This is due to emophasis on the testing of blood before transmission, use
of disposable syringes, and vaccination of newborns. Further, the government too has initiated
several free testing and treatment programs in different states.
Diagnosis of Liver
diseases
Regular diagnosis that includes blood tests are important to keep liver
problems at bay and prevent irreversible damage.
Liver Function Tests (LFT) panel evaluates the liver’s
capability of producing protein and clearing bilirubin or test the levels of
enzymes in the blood.
Besides, ELISA and rapid tests for diagnosis of Hepatitis B
and C are in use to check for these infections in transmitted blood. Transasia
Bio-Medicals offers the complete LFT range of parameters besides ELISA and
rapid tests for Hepatitis B and C.
In fact recently, Transasia has introduced the first and
only Made in India, high sensitivity, 4th generation HCV ELISA
assay.
To conclude, liver disease epidemiology in India is in a transition. Better
screening strategies, more effective linkage to care for early-stage liver disease,
and improved awareness on preventive steps in an integrated way could be useful
interventions.
Sources
* https://pubmed.ncbi.nlm.nih.gov/30266282/
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