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Hepatitis C making more people vulnerable to HIV


PUJA AWASTHO | New Delhi, December 1, 2011 11:30
Tags : hiv | world aids day | hcv | hepatitis c virus |

A new report by International Treatment Preparedness Coalition (ITPC) India and Citizen News Service draws attention to the cohabitation of hepatitis C and HIV infection and how the surge of hepatitis C is leaving more people vulnerable to HIV.

The report has questioned the silence maintained by the Indian Ministry of Health and Family Welfare on its response to the Hepatitis C virus (HCV), which is emerging as a growing public health threat.

It maintains that greater awareness about hepatitis C, more investment of resources, cheaper diagnostic and treatment services, and improved hepatitis-related treatment literacy are all urgently needed by people co-infected with the hepatitis C virus and HIV.

According to the World Health Organization, hepatitis C virus (HCV), a blood borne, viral infection, is a major cause of acute hepatitis and chronic liver disease. Globally, 3 to 4 million persons are newly infected each year. The burden of the disease in India will continue to rise in the absence of prevention and harm reduction measures with vulnerable communities.

"HIV and hepatitis viruses are transmitted in similar ways and it makes public health sense to link HCV prevention efforts to HIV programme" said Naresh Yadav, Chair of ITPC India. This, Yadav suggests can be done by HCV screening in blood banks and prevention and harm reduction efforts for HIV and HCV with vulnerable communities going hand in hand. “Unless this is done, HCV infections will rise in India even though HIV transmission rates reduce, particularly among injecting drug users (IDU), the most vulnerable community," he said.

According to the report the two main obstacles to an effective HCV response are: the absence of prevention efforts; the lack of political will to treat HCV.

Currently, HCV treatment is a combination of two drugs, pegylated interferon and ribavirin. For people who do not clear the virus spontaneously from their body and go on to develop chronic forms of the disease that affects the liver, treatment is currently unavailable in the public healthcare system and unaffordable in the private sector.

The high cost of HCV treatment in India is attributed to the absence of generic competition due to patent barriers. India, as part of its obligations under World Trade Organization's (WTO) international trade rules, had to introduce product patents on medicines in 2005.

Pegylated interferon alpha 2a and alpha 2b, used in the treatment of Hepatitis C, were among the first set of drugs to come under patent monopoly in India. The patents granted by the Indian Patent Office to two pharmaceutical companies - Roche and Schering-Plough, block the development of more affordable generic versions of the drug. As a result both these companies charge exorbitant prices from patients, ranging from Rs. 14,000 to 18,000 per dose.

"People living with HIV are increasingly being diagnosed with HCV co-infection. Hepatitis C, is the "silent killer," threatening to undermine HIV treatment efforts", said Bobby Ramakant, who documented the ITPC-CNS report. "We need not only AIDS medicines but also access to HCV medicines from the government. People are now dying because the price of the HCV drug that can save them is too high. Prohibitive pricing of lifesaving medicines by pharma companies is unethical and unacceptable” said Ramakant.

The report pulls up the government for moving far too slowly on addressing the problems of patients who need HCV treatment. When drugs are patented, and pharmaceutical companies fail to fulfil their obligation to make patented medicines available and affordable to patients, the only way to bring prices down is through examining the validity of the patent granted or compulsory licensing which allows generic production of more affordable versions.
The report makes the following key recommendations:

1. Include Hep-C in surveillance system

2. Initiate Hep-C testing through current ICTCs with proper pre- and post- test counselling

3. Provide free Hep-C treatment to people where medically it is indicated

4. Government must integrate a comprehensive and well-coordinated Hep-C programme within the National AIDS Control programme at NACO as both HIV and HCV interventions are going hand in hand and will maximise AIDS programme performance as well as save lives from Hep C

5. Expand second-line ART coverage and initiate third-line ART in current ART programme and guideline

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Issue Dated: Feb 5, 2017