Balbir Tamang (name changed), hails from Naubise, a small village just outside of Nepal’s capital Kathmandu. He went to India in search of a job three years ago. He was in unsafe sexual relationships with many sex-workers there. After nine months, he fell sick and returned home. His sickness became worse with time. Finally, he took a blood test and was diagnosed HIV positive.
During his medication for HIV, he began experimenting with injecting drugs. After one and half years, his blood test showed that he was infected with Hepatitis C virus (HCV) too. Balbir says he is finding it extremely difficult to deal with the two diseases simultaneously.
Balbir’s is not a one-off case. Like him, many others in Nepal are suffering from HIV-HCV co-infection. The Statistics Department of Health of Nepal Government still does not have an exact data of PLHIV co-infected with Hepatitis C. In Nepal, more than 50,000 people are estimated to be HIV positive, and co-infection with HCV has been found in more than 80% of those people living with HIV (PLHIV) who use injecting drugs.
According to Dr. Sushil Shakya, a senior physician at Bir Hospital Nepal, viral hepatitis co-infection is an increasing cause of morbidity and mortality in PLHIV, including those on anti retro viral treatment (ART). He further adds that he has found co-infection of HIV and HCV in around 80% to 90% PLHIV who are injecting drug users (IDUs).
Hepatitis B and Hepatitis C are liver diseases. Hepatitis B is transmitted through contact with infected blood, semen, or other body fluids; sexual contact with an HBV-infected person; and sharing of contaminated needles. HCV is also a blood borne virus, most commonly transmitted through contact with the blood of an HCV-infected person, primarily through sharing contaminated needles. Less commonly, it is transmitted through sexual contact with an HCV-infected person, or from an infected mother to child during birth. It is estimated that HCV affects 33 million people globally (UNAIDS 2008 report)
A survey was conducted in 2013 by researcher Krishna C Poudel and his team on 319 PLHIV residing in the Kathmandu Valley. 233 of them were on ART and 130 were IDUs. The survey revealed that a total number of 138 (43.3%) study participants were HCV positive. The prevalence of HCV co-infection among IDUs was much higher at 96.2% (125 out of 130). Among the 86 participants not receiving ART, the co-infection rate was 58.1% compared to 37.8% among those receiving ART. In the multivariable analysis, participants who reported lifetime injecting drug use and were also current smokers were more likely to have HCV co-infection.
“HCV is a much smaller virus than HIV, so there is a lot of it even in a tiny amount of blood. Also, HCV is 10 times more infectious than HIV,” says Dr. Shakya. Hepatitis C is one of the most common co-infections associated with HIV. According to WHO, globally, approximately 10%–30% of PLHIV are co infected with HCV. In countries where injecting drug use is the biggest risk factor for HIV transmission, as many as 7 out of 10 PLHIV are co infected with HCV. The risk for HCV infection is less than that for HIV transmission through unsafe sexual practices. Yet, according to experts, it is still a matter of concern that about 1 in 10 PLHIV who do not use drugs through syringes, are co infected with HCV. Experts agree that being co infected with HCV makes treatment of HIV more complicated. A liver damaged from HCV may cause HIV medications less effective and, more importantly, more toxic. HCV co infection triples the risk for liver toxicity from HIV medicines.
The risk of liver disease and liver-related death from co-infection of HIV- HCV is much higher than from HCV alone. The rate of liver damage by HIV speeds up when there is co-infection with HCV. All PLHIV should be tested for HCV. There is no vaccine for HCV, but treatment, which is very expensive, is available. Dr Gourdas Choudhury, Director & Head of Department of Gastroenterology and Hepatobiliary Sciences at Fortis Healthcare, India says that, “We need to create a lot of awareness about the disease as most people are unaware of it. High-risk individuals must go for diagnosis much before symptoms appear. Secondly there should be good hospital practices, more stringent testing for HCV in blood banks, use of disposable syringes/needles which are not reused, and very good management/control of intravenous drug use."
Chhatra Karki, Citizen News Service - CNS
31 July 2014
