From Frying Pan Into Fire: Is Hepatitis C Virus Deadlier Than HIV?

Way back in 1997, an article ‘Hepatitis C: Waiting for the Grim Reaper’ by Alex Wodak published in Medical Journal of Australia, warned of a potential Hepatitis C epidemic, ringing the alarm bells for Australia. The author called this viral infection a public health problem comparable in magnitude with HIV, and argued that as injecting drug use is undeniably the major mode of transmission, encouraging drug users to adopt non-injecting routes of administration may be the most effective way of controlling it.

Fourteen years down the line the grim prophecy seems to have come true, and the world is slowly waking up to the dangers of this deadly disease. The seriousness of the problem can be gauged from the fact that, as of now, there are 15.9 million Injecting Drug Users (IDUs) globally, out of which 10 million are suffering from hepatitis C virus (HCV), and 3 million are living with HIV. Another 5 million people living with HIV (PLHIV) also have HCV.

The global impact of HCV was recognized for the first time in 2010 at the 63rd World Health Assembly (WHA) on viral hepatitis, whose resolution identified the need for a globally coordinated response to address it. However, nothing much seems to have happened as yet on the ground level, and people continue to die of liver complications due to HCV infection. IDUs are particularly vulnerable as transmission of HCV and HIV through infected needles is very common, and sharing needles and other equipment for injecting drugs is a major risk factor, but detailed estimates of the extent of the problem are not available. However, it has been seen that HIV- HCV co-infection leads to poorer treatment outcomes of Anti Retroviral Treatment, and less tolerance of treatment interruptions.

At the recently concluded 10th International Congress on AIDS in Asia and the Pacific (10th ICAAP). in Busan, South Korea, Fabio Mesquita from the World Health Organization (WHO) seconded the fears of Alex Wodak. He said, "In the very near future, all PLHIV may get Anti Retroviral Treatment but they will die of Hepatitis C."

Bijay Pande from Nepal, who is living with TB and HIV, lamented that people in general, and especially PLHIV, are totally uninformed about Hepatitis C. He said that even though, more than 90% drug users (including him) are living with HIV in Nepal, the doctors there are clueless about this disease. So those who can afford it go to India to get tested, and the rest are left at God’s mercy, as the government is too busy with politics and not bothered about people, especially injecting drug users, dying of HCV. He implored the WHO and the Global Fund to influence the government of Nepal to deal with the issue, as civil society is helpless. HCV will not go away on its own, we will have to do something about it and soon.

Fabio Mesquita agrees that, “Progress at the moment is lazy, but advocacy in the right direction is the need of the hour. As of now, the Global Fund alone is supporting HCV funding. We need low cost diagnostic tools for detecting fibrosis in the liver, for that is the time to begin treatment for HCV. The current treatment costs USD 27.70 per day and the regimen lasts for 24 or 48 weeks. So the cost could be anything between USD 4648 and USD 8962. This will have to be brought down.”

In an interview given exclusively to CNS at the 10th ICAAP, Dr JVR Prasada Rao, Senior Adviser to Executive Director, UNAIDS, admitted that, "Hepatitis C is a challenge. It has not been identified till very recently as an important problem. It is largely confined to injecting drug users because when they inject and share needles they not only have a high risk for HIV transmission but also for HCV. Hepatitis C treatment is very expensive; it is much costlier than even Anti Retroviral Treatment. So countries are not able to afford the drugs for HCV. Communities do want effective programmes for hepatitis C and may be in future the drug price can come down just like the prices of ART came down with advocacy, but right now the drug price for hepatitis C is very prohibitive.”

Mauro Guarinieri, of the Technical Review Panel of the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund), also voiced similar sentiments saying that there should be more advocacy from the affected communities for price reduction. He said that the Global Fund supports evidence based interventions and is ready to support diagnosis and treatment. But responses should come from affected communities.

Strong advocacy is needed in the Asia Pacific Region to halt the spread of HCV, especially among IDUs in this region. It is imperative to implement a global hepatitis C program with specific indicators and time frame. This should include affordable access to HCV treatment by reducing costs (perhaps by allowing generic production of pegylated interferon and ribavirin); removing barriers to universal access and harm reduction efforts and opioid substitution therapy (OST) services for IDUs; strengthening human resource and infrastructure capacity for prevention, diagnosis, treatment and management of HCV at country level; including medicines used in current treatment standard for HCV in the WHO List of Essential Medicines; and providing support/resources to civil society, especially IDUs and PLHIV, to be involved  in the design and implementation of WHO programming and policy work at global and local levels.

Only when there is a national commitment to raise levels of awareness about the seriousness of this disease, does the world stand a chance of controlling it, else the trumpet will continue to play on for hepatitis C as it once did for HIV.

Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS) and recently reported on-site from 10th ICAAP, Busan, South Korea for CNS. She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. Email: shobha@citizen-news.org, website: http://www.citizen-news.org)

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