Hepatitis afflicts many HIV/AIDS patients, but there is no policy for them

India has an estimated 9.5 million patients suffering from hepatitis C, and around 2.4 million infected with human immunodeficiency virus (HIV), according to the Indian Council for Medical Research (ICMR). While epidemiological studies clearly establish the link between infection with the hepatitis C virus (HCV) and HIV, there is no data on the number of patients afflicted with both due to the absence of coherent surveillance. The Indian government, too, is yet to lay down a strategy to help patients suffering from HCV and HIV co-infection, and accepted as much in response to a survey by the World Health Organization (WHO), released on July 26 on the occasion of World Hepatitis Day that falls on July 27.

In its response, the Indian government said the country has a drafted a  national strategy that focuses exclusively on the prevention and control of viral hepatitis. It includes components for raising awareness, surveillance, vaccination, prevention in general, prevention of transmission via injecting drugs, prevention of transmission in health-care settings, and treatment and care. The government also stated that it is not known whether there is a “specific national strategy and/or policy for preventing hepatitis B and hepatitis C infections in healthcare settings. However, healthcare workers are vaccinated against hepatitis B prior to starting work that might put them at risk of exposure to blood. "

The government also noted that it has a nodal agency solely to coordinate activities related to viral hepatitis. The agency has four staff members, but the government had no information on how many full-time or contract workers worked for the state or Central governments.

The shifting of responsibility for the care of patients with HCV and HIV co-infection between the Union health ministry and the National AIDS Control Organisation (NACO) seems to be at the root of their neglect. "NACO is reluctant because it looks at only HIV-AIDS. Combining with HCV will increase the burden of work on the agency," said a NACO official on condition of anonymity. He added that the health ministry is wary of making a policy because they do not want to take on the responsibility of caring for AIDS patients.

Co-infection an established fact

A study on prevalence of hepatitis C infection in HIV-seropositive individuals in and around Belgaum in south India, published in American journal PubMed in October 2012, clearly explained the link between HCV and HIV infections. The researchers, led by N B Nagmoti of J N Medical College in Belgaum, Karnataka, investigated the prevalence of HCV infection in HIV seropositive individuals. The subjects were taking treatment in a tertiary care hospital at Belgaum. A total of 16,124 serum samples from suspected patients were screened for the presence of HIV antibodies. Those who tested positive for HIV were screened for HCV antibodies by using enzyme-linked immunosorbent assay (ELISA). The study found that 24 (3.52 per cent) patients were co-infected with HIV and HCV. "This study has revealed a relatively high prevalence of HIV and HCV co-infection in and around Belgaum, which suggests preventive and control measures should be taken against the spread of such infection in this part of India,” the researchers noted.

Medical experts say this co-infection is well-established and India needs to prepare a policy to treat both under one programme. "HCV and HIV are interconnected because of the same route of transmission. The main source of HCV infection is through syringes. Thus a population which is susceptible to HIV will be vulnerable to HCV, too. It is also transmitted from mother to child," said Ravindra Rao, assistant professor with National Drug Dependence Treatment Centre at the All India Institute of Medical Sciences.

G Charanjit Sharma, programme manager for Harm Reduction and Drug Use, India HIV/AIDS Alliance, said that hepatitis C is emerging as a serious problem in the country but there are no policies or guidelines to tackle this. “While working on our programme we have seen that hepatitis C is a common problem among people who inject drugs. We have approached the authorities and are awaiting their response on this.”

At the national level, cases of HIV and hepatitis are registered. However, in the absence of a policy to act on the data thus gathered, patients will continue to suffer. At a press conference held on July 25, Anand Grover, member of the non-profit Lawyer's Collective said that the failure of the health ministry to start prevention and treatment efforts is driving this hidden epidemic in India. It is time to hold the government accountable for protecting both public health and the right to health.





 

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