Hepatitis C: A Ticking Viral Time Bomb

(MNP+) *

Hepatitis C is a blood-borne infection that affects the liver, caused by the hepatitis C virus (HCV). The disease usually has no symptoms in the early stage, but once established it can cause liver damage and eventual liver failure. There are several different strains of HCV, called genotypes. In India, the most common is genotype 3. Fortunately, this genotype is responsive to treatment and less susceptible to relapse.

HCV is transmitted in blood, and the most common route of infection is needle-sharing. HCV is very rarely passed on through sexual contact; doctors believe that this only happens where there are open wounds or ulcers from STIs.

It will be good if we could screen all HIV infected persons of HCV infection. Prevention of HCV infection for those not already infected and reducing chronic liver disease in those who are infected are important concerns for HIV-infected individuals and their health care providers. Person living with HIV who are not already co-infected with HCV can adopt measures to prevent acquiring HCV. Such measures will also reduce the chance of transmitting their HIV infection to others.

Hepatitis C is mostly transmitted by direct blood-to-blood contact. The most common route of transmission is by sharing equipment for injecting drug use, mainly via blood-contaminated needles and syringes, but sexual transmission does occur. The virus can survive in syringes and in tubs of lubricant for weeks. Sharing drug sniffing equipment (straws or banknotes) has also been shown to be a risk.

Many people also contracted hepatitis C from being given blood products in a medical procedure before screening and sterilisation processes were introduced. Sexual transmission of hepatitis C is less common but does occur. It is more likely to happen if you also have another sexually transmitted infection.

Also, anal or rough sex is more likely to pass on the infection. Oral sex is of low risk. The virus is present in saliva, but kissing is not usually a risk unless both partners have cuts in the mouth or bleeding gums. In recent years, there has been a large increase in also become infected with hepatitis C through sexual transmission.

There seems to be an association with rougher sex, with risk factors such as fisting, group sex and using recreational drugs during sex, but sometimes the only identifiable risk factor is unprotected anal sex.

There is also evidence that some of the infections in HIV-positive gay men may be as a result of injecting drug use and other shared routes of drug taking. There is little evidence of sexual transmission of hepatitis C in heterosexuals.

Mother-to-child transmission of hepatitis C is uncommon, but the risk is increased if the mother is also infected with HIV. A high hepatitis C viral load also increases the chance that a mother will pass on hepatitis C to her baby. As with HIV, a caesarean delivery reduces the chance of mother-to-child transmission of hepatitis C.

Unlike hepatitis A and B, having hepatitis C once does not mean you are then immune from getting it again. It is also possible to be reinfected with a different strain of hepatitis C.

It will be good if we could screen all HIV infected persons of HCV infection. Prevention of HCV infection for those not already infected and reducing chronic liver disease in those who are infected are important concerns for HIV-infected individuals and their health care providers. Person living with HIV who are not already co-infected with HCV can adopt measures to prevent acquiring HCV. Such measures will also reduce the chance of transmitting their HIV infection to others.

The most crucial part for treatment for the PLHA who are co-infected with HCV and HIV is that there is no component for treatment for PLHAs who are co-infected with HCV and HIV in the National and State Policy. It is need of the time to initiate this component otherwise PLHAs are killing more by HCV than HIV itself. There is no signal from the Govt. side for this treatment component. As of now, India does no surveillance on HCV prevalence, partly because HCV diagnosis is complicated and expensive.

Several reasons, such as a lack of healthcare provider knowledge on HCV and inadequate diagnostic facilities, are factors in the limited availability of HCV treatment. Stigma plays a role; perhaps because the hepatitis C demographic is primarily IDUs, the government does little to make treatment available.

The major reason that HCV treatment is inaccessible is its excessive price due to patent protections. There are currently two formulations of peg-IFN on the market, manufactured by Roche Pharmaceuticals and Schering-Plough. Both these forms of peg-IFN are patented. This ensures that no generic production is possible and that all variations of the standard combination therapy must be obtained from these companies at high cost.

HCV treatment is not available in government hospitals and despite the high rates of co-infection, it is not offered as part of ART rollout. In fact, many treatment programs do not even screen for HCV, since the cost of treatment makes it a pointless venture. For the majority of India's population, the exorbitant price on combination therapy amounts to their lifetime income. The patent protections ensure that treatment is out of reach for the millions of HCV-infected Indians that need it.

Unfortunately, many IDUs in India are co-infected with HCV and HIV, particularly in Manipur. In two studies of HIV+ IDU in north-eastern India conducted by ICMR in 2001-2001, HCV prevalence among IDU was reported at 92% in Imphal and 98% in Churachandpur.

Ironically, though Imphal, Manipur has HIV/HCV co-infection rates as high as 92%, government rollout programmes only offer ARV therapy for HIV treatment and people are living longer, healthier lives with HIV. However, liver disease is now a major cause of hospital admission and death among HIV-positive people because of hepatitis C liver-related problems.

Having hepatitis C does not appear to significantly alter your chances of becoming ill due to HIV, developing AIDS, or dying of an AIDS-defining illness.

Unlike HIV, for which the general public is considered at risk, hepatitis C is considered a disease of the IDU community, and is thus a marginal epidemic.

The World Health Organisation (WHO) describes hepatitis C as a "viral time bomb" and estimates that 130 million people worldwide, with 12 million in India, are chronically infected. Since sharing needles is the most common transmission route, HCV heavily impacts injecting drug user (IDU) populations.