Hepatitis C is a common co-infection among people living with HIV (PLHIV). By Dr Sanjay Sarin
While World AIDS Day comes annually as a reminder to continue creating awareness about the affliction, it is no reason why we must stop at that. Not only is it important to understand what causes AIDS but what HIV and HCV are as well.
Globally, 70 million people are estimated to be chronic carriers of Hepatitis C, out of which only one per cent are aware of their status and an even smaller number getting treatment. Four out of five people with HCV don’t know their status. Situation is no different in India except states like Punjab and Haryana which have pioneered in HCV response through state sponsored programs.
Hepatitis C is a disease of the liver caused by the hepatitis C virus (HCV). Hepatitis means swelling of the liver, and it has many different causes including HCV infection that can cause both acute and chronic hepatitis ranging in severity from a mild illness lasting a few weeks to a serious, lifelong illness, if not treated. HIV, the human immunodeficiency virus, is a retrovirus that causes HIV infection and, if not treated, over time causes AIDS. Both, HIV and HCV are blood borne pathogens and have common routes of transmission through infected blood and blood products. Therefore, Hepatitis C is a common co-infection among people living with HIV (PLHIV).
Presence of HIV infection further compounds the harmful effects of HCV infection in form of higher rate of viral persistence, increased viral loads, a faster rate of fibrosis progression, and higher rates of jaundice and enlargement of liver and liver failure. It is estimated that 2.3 million people around the world have an HIV/HCV coinfection.
HCV infection remains asymptomatic for a long time which makes early diagnosis of HCV even more challenging because during the gestation period, the disease does not manifest itself through any specific symptoms. HCV symptoms may only become evident when the patient is in the advanced stages of liver disease, which might be too late, or too complicated, to treat.
Progression of HCV infection is fast in the presence of HIV infection and it remains asymptomatic for long. Therefore, all PLHIVs and vulnerable populations (injecting drug users, patients on hemodialysis, geriatric patients, healthcare workers, multiple sexual partners, those in close contact with a HCV infected patient, have body piercing and tattoos etc.) need to be routinely tested for HCV.
It is important to know your status to ensure early detection and initiation of Hepatitis C treatment in HIV/ HCV co-infected patients to minimise hepatitis related liver disease and its long-term negative impact on HIV outcomes. Thus, it’s so important to have strategies in place for early detection of HCV.
Currently, there is no nationally representative data for estimating hepatitis disease burden in India. In the absence of a reporting mechanism, it is difficult to estimate the number of cases of various types of hepatitis infections. The HCV prevalence rate amongst key populations such as PLHIVs and PWIDs (people who inject drugs) is expected to be higher than HCV prevalence rate amongst general population. This is primarily due to sharing of infected needles and syringes. This high-risk behavior makes PWIDs vulnerable to both HIV and HCV infection.
To know your status, one needs to undergo a simple Hep C antibody screening blood test and if found positive, a confirmatory Hep C RNA Test needs to be carried out. If the presence of HCV infection is confirmed, then persons need to undergo some baseline tests before the initiation of treatment.
Knowing your status alone is not enough, and if found positive for HCV infection, linkage to treatment is critical to avoid long terms complications. The current Direct Acting Antiretroviral treatment is simpler, safer, shorter and relatively affordable and can cure more than 95 per cent of HCV patients.
The Government of India has launched the National Viral Hepatitis Control Program on 28 July 2018 under the National Health Mission to control viral hepatitis, with a view to provide free of charge screening, diagnosis, treatment and counselling services to all, and specially to people belonging to high-risk groups.
Recent advances in diagnostics have now made it possible to diagnose people carrying viral hepatitis infections through point-of-care rapid diagnostic tests. Several new technologies and platforms are also now available for conducting screening and confirmatory tests. Along with technical and programmatic advances, it is also important to create awareness around HCV infection and its risk factors within the general population as well as the PLHIVs and other high risk groups to move towards realisation of vision for elimination of viral hepatitis by 2030.
(The writer is the head of a global non-profit organisation.)