Living with HIV but dying of co-infections, co-morbidities

Bobby Ramakant - CNS
Neglecting Hepatitis C Virus (HCV), Hepatitis B Virus (HBV), Visceral Leishmaniasis (VL), tuberculosis (TB), among other HIV co-infections and co-morbidities threaten to reverse gains made by remarkable scale up of HIV specific services. Number of people who inject drugs (PWID) with HCV is 3.5 times higher than those infected with HIV. Number of people infected with HBV is not behind at 6.4 million PWID exposed to it in 59 countries. 1.2 million PWIDs are estimated to have developed chronic HBV infection.

Evidence backs that providing anti retroviral therapy (ART) to HIV-HCV co-infected people is cost-effective and makes public health sense. Otherwise advancing HIV related illnesses lead to HCV progression. TB continues to be a major killer of people living with HIV (PLHIV) despite significant increase in bidirectional screening of TB patients for HIV and PLHIV for TB. Pilot studies done in India show public health benefits of doing bidirectional screening of people with diabetes and PLHIV too.

Dr Anthony Harries, Senior Advisor, International Union Against Tuberculosis and Lung Disease (The Union) said in a webinar that "HIV-associated TB can be controlled by better scale up and implementation of tools that are currently available. For example, we need to get more HIV-infected people earlier on to ART. We need to test all patients with TB for HIV, and those who are HIV-positive need to start ART and cotrimoxazole preventive therapy as soon as possible."

"HIV programmes in Uttar Pradesh need to scale up collaborative activities to respond to TB-HIV, hepatitis C virus (HCV) and hepatitis B virus (HBV) co-infections, and other co-morbidities such as non-communicable diseases (NCDs) like cardiovascular diseases (CVDs), diabetes, cancers, among others. Number of people on ART has gone up in the state over last years but co-infections, co-morbidities and drug stock outs threaten to reverse the gains" said Naresh Yadav of Uttar Pradesh Network of People living with HIV (UPNP+) and International Treatment Preparedness Coalition (ITPC).

Similar areas of potential synergies to optimize public health benefits exist to meet needs of women to protect themselves from HIV, other sexually transmitted infections, and unintended pregnancies. Multipurpose prevention technologies (MPTs) can play an important role not just in HIV prevention, but in addressing the spectrum of women’s sexual and reproductive health needs. Instead of vertical programmes we need to connect the dots to optimise public health outcomes.

Bobby Ramakant, Citizen News Service - CNS
December 2013