An estimated 50 million people worldwide suffer from hepatitis C, a bloodborne virus causing inflammation of the liver that can lead to cancer, cirrhosis, and even death. The virus is highly prevalent in Pakistan, where Doctors Without Borders/Médecins Sans Frontières (MSF) teams are working to eliminate the virus in Machar Colony, Karachi, by the end of 2024.
As part of MSF’s operational research, we have implemented an innovative “bending the curve” model of care, which focuses on scaling up screening and testing for all residents aged 12 and up in order to identify and treat cases swiftly and curb the spread of the virus.
Muhammad Ahsan, an MSF patient, shared his story of how he was finally cured of a resistant form of the virus through our free hepatitis C treatment program, which provides patient-centered care and access to second- and third-line regimens for those in need.
On the brink of death
“I felt as if I was on the brink of death,” recalled Ahsan, sitting anxiously outside MSF’s hepatitis C facility in Machar Colony awaiting his third post-treatment test. “I had no idea what was happening to me. I was so weak, and I couldn’t even move. My family was worried—my children were young and I was the only breadwinner. I felt like I was leaving them behind."
Ahsan’s journey began eight years ago when he was diagnosed with hepatitis C. At the time, he was a robust 150 lbs., but his weight soon plummeted to a mere 82 lbs. Originally from Gujrat, over 740 miles from Karachi, he had spent 25 years in Soldier Bazar before returning to his village last year. Initially, he experienced pain in the back of his legs and frequent hiccups after eating. A doctor suggested a liver test, which confirmed he had hepatitis C.
The most common risk factors for the spread of the hepatitis C virus (HCV) are the re-use of needles and razor blades, unsafe health care practices, and sharing everyday household items such as combs or toothbrushes, as it is transmitted through blood. If left untreated for too long, hepatitis C can progress to end-stage liver disease and even liver cancer. Many people are only screened for HCV infection when they start showing symptoms of liver disease, which is often too late. With the magnitude of HCV infection in Pakistan, every individual should undergo screening for it at least once a year, regardless of signs and symptoms.
Putting life on hold
Ahsan first sought treatment at Jinnah Hospital, where he underwent a three-month course of medication, which was ineffective. “I was devastated. I had pinned all my hopes on that treatment, and it failed me. I felt like I was running out of options.”
Desperate for a solution, he turned to a a traditional healer, or hakeem, in Layeh who provided him with herbal medicine. After taking these herbs, Ahsan said, “I felt better, but my hepatitis C tests continued to show positive results on the PCR [polymerase chain reaction] test.”
Ahsan’s life was put on hold as he battled hepatitis C. Despite his determination to provide for his family, he was forced to rely on loans from friends to cover basic needs. His inability to work took a toll on his family’s well-being, leaving them in a vulnerable position.
Last year one of Ahsan’s friends in Karachi told him about the free treatment available at the MSF clinic, and he decided to give it a try. “I was desperate for a cure, and I had heard good things about MSF from my friend. I knew it was my last chance, and I was willing to try anything.”
After an initial assessment, medical examination, and tests, he started his HCV treatment. The first line of treatment for hepatitis C infection at the MSF clinic is a 12-week course of direct-acting antivirals sofosbuvir and daclatasvir.
“In some patients, the hepatitis C viral infection is resistant and cannot be cured with this treatment course,” explained Dr. Natasha Mustafa, who works at the MSF clinic in Machar Colony. “This can be because the virus is resistant to the first-line treatment or the patient struggles to adhere properly to the medication regimen, including issues like discontinuing treatment before it’s finished.”
Resistant virus requires aggressive treatment
Despite completing three courses of treatment, Ahsan’s post-treatment tests kept showing positive results for hepatitis C. “I was anxious and worried, but the MSF staff were kind and supportive. They treated me with respect, unlike other hospitals where I felt like just a number.”
Dr. Mustafa explained that if the hepatitis C infection persists for three months after completing the initial treatment, then it is time to proceed with the second line of treatment. “This involves a different combination of medications, including sofosbuvir and velpatasvir. The treatment cycle is repeated: a 12-week treatment course followed by a 12-week drug-free gap and then another PCR test. Unfortunately, some patients are infected with a resistant virus or develop resistance to direct-acting antiviral drugs and cannot be cured even with second-line medication.
For these patients, there is a possibility for third-line regimen: a combination pill of sofosbuvir, velpatasvir, and voxilaprevir (sofvelvox).
After returning to his village last year, Ahsan continued his treatment at the MSF clinic. “It was a struggle, but I knew I had to keep fighting. I had to be strong for my family, for my children.”
Finally, after his third post-treatment test, Ahsan received the news he had been waiting for–his report was negative, indicating that he had been cured of hepatitis C.
Our work treating hepatitis C in Pakistan
MSF has been a dedicated health care provider in Karachi’s Machar Colony since 2012. In 2015, MSF established a comprehensive hepatitis C program, offering a full spectrum of services—screening, diagnosis, treatment, health education, and patient support—all under one roof at the primary health care level.
In 2023 MSF conducted 45,377 rapid diagnostic tests and 6,480 PCR tests, mobilized 58,078 people for awareness and testing, initiated life-saving antiviral treatment for 1,942 patients, and ultimately cured 981 people with hepatitis C.
