Diagnosing HCV in HIV co-infected population and where India stands

www.healthysoch.com

New Delhi, February 12, 2019:

Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) co-infection refers to the condition where a person is infected with both viruses at the same time. Both HIV and HCV are blood-borne pathogens and have common routes of transmission through blood and blood products. Hepatitis C is a disease of liver caused by HCV that can cause both acute and chronic hepatitis C, ranging in severity from a mild illness, lasting a few weeks to a serious life threatening illness, such as liver cancer, if not treated.

Currently, there is no national representative data for estimating the disease burden in India. In the absence of a streamlined reporting mechanism, it is difficult to estimate the number of cases of various types of hepatitis infections. In India, population prevalence of hepatitis C is around 1%, which amounts to an estimated 12 million people in India who are likely to be infected with HCV

Some facts you must know about HIV and HCV Co-infection:

  • Globally, 71 million people are estimated to be chronic carriers of hepatitis C, but 4 out of 5 people (80%) do not know their status and only 7% are receiving treatment.
  • WHO has set an ambitious target of viral hepatitis elimination by 2030 to support Sustainable Development Goal 3. India is also a signatory to the World Health Assembly resolution and the country’s vision is to move towards elimination of Viral Hepatitis by 2030. Through adoption of a simplified and accessible service delivery approach to promote access to testing of Hepatitis C and access to HCV diagnosis & treatment.
  • All vulnerable populations (such as people who inject drugs, patients on haemodialysis, geriatric patients, healthcare workers, people engaging with multiple sexual partners, those in close contact with an HCV-infected patient, have body piercing and tattoos etc.) are more at risk of being infected with HCV.
  • Despite various safety measures, blood received from donors, still in window period, is a matter of concern, as it is difficult to detect the infection at the blood banks.
  • Both HIV and HCV can be transmitted through the blood and by sharing needles, blades or any instrument coming in direct contact with an infected person’s blood.
  • Progression of HCV infection speeds up in the presence of HIV infection, although it can remain asymptomatic for a long time. HCV infection remains asymptomatic for a long time, which makes early diagnosis challenging because, during the gestation period, the disease does not manifest itself through any specific symptoms. According to a study tested among 14,481 PWIDs in 15 cities across India – The prevalence of HIV among this population was found to be 5.7%, however the Hep C prevalence was 25.6% and prevalence of coinfection of Hep C and HIV was 14.4%. In addition to this, 6 of the 15 cities showed a co-infection of higher than 30%.
  • The HCV prevalence rate in vulnerable populations (such as those living with HIV, and those who inject drugs) is expected to be higher than the HCV prevalence rate in the general population. This is primarily due to sharing of infected needles and syringes. This high-risk behaviour makes people who inject drugs vulnerable to both HIV and HCV infections.
  • All diagnosis tests are free of cost under National Viral Hepatitis Control Program (NVHCP) at designated hospitals and ART/testing centres
  • The Government of India launched the National Viral Hepatitis Control Program (NVHCP) on 28 July 2018, under the National Health Mission to control viral hepatitis, to provide free-of-charge screening, diagnosis, treatment and counselling services to all, and especially to people belonging to high-risk groups
  • It is critical for people living with HIV to know if they are coinfected with HCV to allow early initiation of treatment that can minimize hepatitis-related liver disease, and the long-term negative impact on HIV outcomes.

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.

 

“– Dr. Sanjay Sarin, Country Head, FIND India”

 

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