Double-Trouble: HIV and hepatitis C virus (HCV)

In communities where sharing of injecting equipment drives the HIV epidemic, a parallel epidemic of hepatitis C virus (HCV) often lurks quietly. A couple of days before the World Hepatitis Day, 28 July, Dr Victor Lo Re, an infectious disease researcher at the University of Pennsylvania, presented data on the impact of HIV and HCV co-infection at the XIX International AIDS Conference (AIDS 2012). His work shows that, despite effective antiretroviral therapy, people co-infected with HIV and HCV remain at higher risk of liver deterioration and other liver-related complications than those with HCV alone.

During a press conference on HIV and HCV treatment access issues jointly organized by the Asian Network of People living with HIV (APN+), International Treatment Preparedness Coalition (ITPC) and Citizen News Service (CNS), Eldred Tellis, Director of the Sankalp Rehabilitation Trust, Mumbai, India, said: "HIV and HCV are transmitted in similar ways and it makes public health sense to link HCV prevention efforts to HIV programmes. Prevention and harm reduction efforts for HIV and HCV with vulnerable communities should go hand in hand. Unless this is done, HCV infections will rise even though HIV transmission rates reduce, particularly among injecting drug users – the most vulnerable community."

Experts say the most common risk factor for hepatitis C infection is through sharing contaminated needles when injecting drugs. The virus is responsible for around one in four cases of liver cancer and 20% of chronic liver diseases. The infection can cause liver inflammation that is often asymptomatic. Chronic hepatitis can lead to cirrhosis and liver cancer.

"People living with HIV are increasingly being diagnosed with HCV co-infection. We not only need the AIDS medicines but also access to HCV medicines from the government,” said Loon Gangte, secretary of the Delhi Network of Positive People (DNP+) who also leads ITPC South Asia. "Hepatitis C transmission rates are higher than that of HIV and the condition is often more severe in injecting drug users. People who share injection equipment are one of the populations more vulnerable to HCV and HIV infection."

Hepatitis C is a blood borne virus so unless anyone comes into contact with blood from someone with hepatitis C there is no risk of transmission. To prevent transmission, it is advisable for people living with hepatitis C not to share anything that may have come into contact with their blood such as toothbrushes, razors and manicuring tools.

Currently hepatitis C treatment consists of a combination of two drugs, pegylated interferon and ribavirin. For people who do not clear the virus spontaneously from their body and go on to develop chronic forms of the disease that affects the liver, treatment is currently unavailable in the public healthcare system and unaffordable in the private sector. In India, the high cost of hepatitis C treatment is attributed to the absence of generic competition due to patent barriers.

At the above mentioned press briefing, a report on HIV and HCV treatment access issues in India was released. The report includes recommendations for governments to integrate a comprehensive and well co-ordinated hepatitis C programme within National AIDS Control programmes; provide free hepatitis C treatment to people; initiate hepatitis C testing through current integrated counselling and testing centres with proper pre- and post- test counselling, and include hepatitis C in surveillance systems.

As part of its Delivering Hope program the Bristol-Myers Squibb Foundation has awarded four new grants totalling US $1.69 million to improve prevention, care and support for people in China and India with hepatitis B and hepatitis C. The grants, announced to coincide with yesterday’s awareness day, support initiatives to empower hepatitis patients to take an active role in disease management and advocacy. China and India together have an estimated 123 million people chronically infected with hepatitis B and 59 million people chronically infected with hepatitis C, accounting for almost 50% of all hepatitis B and hepatitis C infections worldwide.

Greater awareness about hepatitis C, more investment of resources, cheaper diagnostic and treatment services, and improved hepatitis related treatment literacy are all urgently needed by people co-infected with the hepatitis C virus and HIV.

Ishdeep Kohli
(The author serves as the Vice President, Jodhpur National University; and also as the Executive Director of Swasthya India. She has written extensively on HIV and health issues)