Hepatitis C, a disease that closely mimics the deadly HIV infection, has been ignored for long, say medical experts. The chronic liver infection caused by the blood-borne hepatitis C virus (HCV) kills nearly 96,000 people in India annually. This, despite the fact that the availability of a range of new drugs has drastically improved its cure rate to over 95%.
Testing for two
Experts also point to the threat of HCV co-infection with HIV, given that both diseases have same routes of transmission. “The need of the hour is to integrate HCV testing and treatment as a component in the already existing national programme for HIV,” says Dr. V. Sam Prasad, country manager, AIDS Healthcare Foundation, adding that instead of designing a new programme that may take years, tweaking an existing programme would be simpler and faster. He says just like HIV, that now has a ‘test and treat’ policy as a part of the Antiretroviral Therapy (ART) guidelines, a revised version could add a similar approach for HCV.
Like HIV, HCV can be transmitted through injectable drug use through the sharing of needles, reuse or inadequate sterilisation of medical equipment such as syringes and needles, and transfusion of unscreened blood and blood products. Though very uncommon, it can also be transmitted sexually and can be passed from an infected mother to her baby.
According to Dr. A.R. Pazare, head of the medicine department at Mumbai’s King Edward Memorial (KEM) Hospital, the cure rate of HCV was extremely low till about five years ago as there were merely two drugs to treat it. “But now, as many as 30 new drugs are now available. They have become a game changer for the disease,” he says, adding that despite this, the threat of disease continues due to the overlapping modes of transmission with HIV.
“We should react quicker to curb it. Also, there is extremely low awareness about the disease.”
Co-infection cases
Approximately 12 million people in India are chronically infected with hepatitis C. Globally, 2.3 million people living HIV are co-infected with HCV of which nearly 1.3 million are injectable drug users. While India lacks data on co-infections, rough estimates state that 60,000 people with HIV also have HCV.“It is highly impossible that these estimates are accurate,” says Dr. Prasad, adding that the disease often presents no symptoms and hence is diagnosed very late. “In most cases, liver cirrhosis or fibrosis sets in by then,” he says, adding that 20% of the patients are unaware of their status.
A 2010 article published in the Indian Journal of Sexually Transmitted Diseases cited the results of a study carried out in the Department of Microbiology, Nair Hospital, Mumbai to track the co-infections of HIV with hepatitis B virus (HBV) and HCV. Of the 540 HIV seropositive patients, 90 (16.7%) were positive for HBV and 7 (1.3%) were positive for HCV antibodies. While heterosexual high-risk behaviour was observed in 435 (80.6%) patients, 15 (2.8%) patients had a history of blood transfusion. Two patients (0.4%) who were intravenous drug users were positive for HIV, HBV and HCV. The article lay emphasis on the necessity of integrating HIV and HBV/HCV care into the National AIDS Control Programme and commence interventions and treatment guidelines for patients with HIV and HBV/HCV co-infection.
A study published last year in The Lancet too stated that not only are people with HIV at much higher risk of HCV infection, groups such as people who inject drugs have an extremely high prevalence of HCV infection — over 80%. “There is a need to scale-up routine testing to diagnose HCV infection in HIV programmes worldwide, especially among high-risk groups, as the first step towards accessing the new, highly curative HCV treatments,” said an official of the World Health Organization, which had commissioned the study.
jyoti.s@thehindu.co.in
