HIV plus Hepatitis C takes a heavy toll
Source: The Sangai Express

Imphal, April 20 2012: Even as a large number of people infected with HIV have received a new lease of life following introduction of ART drugs, many people infected by both HIV and Hepatitis C have been literally left to their own fates in the absence of any Government policy or programme for their medical test, diagnosis and treatment.

At the least, Rs two lakhs to Rs six lakhs are required for diagnosis and treatment of people co-infected by HIV and Hepatitis C.In addition to the high cost of treatment, recovery rate is rather disappointing.

Even if one is said to have recovered, the number of such patients getting relapsed is quite high.

As such, people infected by both HIV and Hepatitis C have been literally caught between the proverbial devil and the deep sea.

Generally, Hepatitis C Virus (HCV) is transmitted through blood transfusion, sexual intercourse and sharing of syringes among drug users.

Once inside a human body, HCV attacks vital organs including liver.

Symptoms generally associated with Hepatitis C are physical weakness, loss of appetite, loss of body weight and yellowing of eyes.

After showing these symptoms, the person would be ultimately infected by liver cirrhosis and liver cancer.

As per a study conducted by the Asian Network of People Who Use Drugs on diagnosis, management and treatment of Hepatitis C Virus in India, Indonesia, Malaysia and Nepal, the rate of Hepatitis C virus transmission among people who inject drugs in India is 92 per cent.

Talking with The Sangai Express, retired ART nodal officer of JNIMS Dr K Priyokumar said that out of 107 people admitted in JNIMS between 2005 and 2008 in connection with HIV infection, 67 patients were found co-infected by HIV and Hepatitis C while 40 patients were infected by Hepatitis C alone.

Of the 67 patients co-infected by HIV and Hepatitis C, 63 were found to have been infected by two diseases due to injection of drugs.

Two got infected due to blood transfusion while the remaining two got infected due to sexual intercourse.

Of the 40 people infected by Hepatitis C alone, 25 got infected due to injection of drugs, 10 through blood transfusion and the remaining five through sexual routes.

From the time ART centre was first opened at JNIMS (then called JN Hospital) in December 2004 till August 2011, 493 people living with HIV have died.

Out of the 493 people, 91 were co-infected by HIV and Hepatitis C .

Till July 2011, there were 3983 people who were taking ART drugs at JNIMS.

Out of them 738 were infected by both HIV and Hepatitis C while 133 were co-infected by HIV and Hepatitis B .

All these figures are for JNIMS only.

Exact figures of the number of people who were co-infected by HIV and Hepatitis C, and the number of people who have died due to the dual infection could not be put in this report as the same data could not be obtained.

Nevertheless, a study conducted by SASO found that 36 female injecting drug users have been infected by both HIV and Hepatitis C .

Among the clients of Project Orchid undertaken by SASO in Imphal East district, 30 people have been co-infected by HIV and HCV.

Among the clients of Imphal West Project Orchid, 33 people have been co-infected by HIV and HCV while 12 people have been found positive for HCV alone.

255 people among the clients of CRS taken up by SASO at Singjamei have been found co-infected by HIV and HCV.

The corresponding figure for Kakching is 7 .

SASO general secretary Sashikumar said that treatment for Hepatitis C has not been started on these people who have been co-infected by HIV and HCV .

He conceded that they could not start the treatment process even after knowing that many of the clients have been infected by both HIV and HCV because of the high cost of treatment.

The situation demands immediate and special attention of MACS.

The State Government too should make necessary arrangements to ensure that diagnosis facility for Hepatitis C is available in Manipur in addition to ensuring that the drugs for treatment are available at subsidised rates, Sashikumar said.

Likewise, among the clients of Opioid Substitution Therapy (OST) undertaken by Manipur Network of Positive People, 112 have been infected by both HIV and HCV while 168 have been infected by HCV alone.

While interacting with this reporter, Counsellor of the OST centre A Sunil said that treatment of the HCV positive people could not be started as they have no money besides having little knowledge about the disease.

Dr K Priyokumar said treatment of people co-infected by HIV and HCV often entails many complications besides being very costly.

It is far more easier to treat people infected by HCV alone.

For treatment of HCV on people who have been co-infected together with HIV, they should have 300 CD4.If their CD4 count is less than 300, it must be first increased to 300 at the least before any treatment process is started.

Before undergoing any treatment, patients should first undergo HCV-PCR test.

By conducting this test, the qualitative aspect of the virus can be verified.

After this genotype of the virus would be identified.

This preliminary diagnosis costs around Rs 15,000 .

After conducting these two tests, the patients would be treated either under Pegylated-Interferon and Rabivarin method or Plain-Inteferon and Ribavarin method for one year.

The first method costs around Rs five to six lakhs while the second method costs around Rs two to three lakhs, explained Dr K Priyokumar.

Even as the State has no policy for treatment of HCV positive people, some drugs have been made available at subsidised rates with the help of private companies.

With the objective of controlling transmission of HIV and HCV, a programme to reduce sharing of syringes is being undertaken under NACO.

Moreover, OST programme is also being implemented with a view to reduce heath hazards posed by injecting drugs.

On the other hand, one individual who has been co-infected by both HIV and HCV said wistfully, "The money required for HCV treatment would be saved for my child's future rather than spending it on my treatment" .

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