HEALTH: Hepatitis-C Virus Hinders HIV Therapy in India’s Northeast

By Ranjit Devraj Reprint | | Print |

Ranjit Devraj

IMPHAL, India, Mar 14 2005 (IPS) - As funds pour into India’s ambitious programme of providing free anti-retrovirals (ARVs), it is becoming clear that many HIV-infected people in the north-eastern Manipur state – where the fight against AIDS is threatening to get out of control – will be left out.

This is due to the high prevalence of hepatitis-C co-infections among the Manipur people.

”Putting someone with hepatitis-C on anti-retroviral therapy (which can be toxic to the liver) is like passing a death sentence on him,” said Hijam Dineshwar Singh, president of the Kripa Society – a leading voluntary agency that works with injecting drug users (IDUs) infected with HIV – the virus that causes AIDS.

ARVs are substances used to kill or inhibit the multiplication of retroviruses such as HIV.

Manipur’s predicament arises from the fact that 72 percent of HIV cases in the state involve IDUs who share infected needles and syringes. This contrasts sharply with the fact that 86 percent of all HIV infections in other parts of the country is through sexual contact.

Although it is not well established, hepatitis-C infections do not easily take place through the sexual route and is therefore regarded as a problem confined largely to drug injectors.

Proximity with Burma and the heroin-producing ‘Golden Triangle’ countries of Laos and Cambodia have resulted in Manipur becoming an important transit point for high-grade heroin. The free availability of heroin has also resulted in the exponential rise of injecting drug users – many of whom are doubly exposed to HIV and the hepatitis-C virus, which attacks the liver.

According to published official figures, more than 70 percent of Manipur’s estimated 20,000 people living with HIV/AIDS are IDUs. At least 90 percent of this high-risk group also carries the hepatitis-C virus, which rules out the use of ARVs – which are toxic to the liver – to arrest the effects of the AIDS-causing virus.

Manipur and adjoining Nagaland are among the six worst affected Indian states (including southern Andhra Pradesh, Karnataka and Tamil Nadu, western Maharashtra) chosen to benefit from a free ARV therapy programme supported by the Geneva-based Global Fund to fight AIDS, Tuberculosis and Malaria.

This month formalities were completed for the first tranche of grants worth 18.2 million U.S. dollars from the Global Fund which has so far committed 413 million dollars to India, of which 265 million dollars will go towards HIV treatment in the six states.

India’s Health Ministry, that began a programme of providing free ARV treatment with a total budget of 100 million dollars, has massively scaled up its spending. In this year’s annual budget alone, 750 million dollars has been allocated for ARV therapy – and this is due to be voted in by parliament this month.

The World Bank-funded National AIDS Control Organisation (NACO) has announced plans to put at least 500,000 people on free ARVs by 2006, but even this is considered inadequate to meet actual requirements.

Official statistics put the number of people living with HIV/AIDS at 5.1 million in India, slightly lower than the 5.6 million in South Africa. However, the Global Fund’s executive director Richard Feachem has said he believes that the number of people with HIV in India has already surpassed South Africa.

In Manipur the new grants could help scale up the number of people on free ARVs from the present 300 to 1,000 during the current year, said Prof. Brajachand Singh, an expert on virology at the Regional Institute of Medical Sciences (RIMS). RIMS is charged with deciding who can get on the ARV therapy programme.

But the fly in the ointment is the fact that the huge numbers of people infected with HIV, in Manipur, also carry the hepatitis-C virus.

One obvious way out, said Brajachand Singh, a Commonwealth Medical Fellow in the diagnosis and treatment of viral infections, is to first treat patients for hepatitis-C using drugs like Interferon and Ribavirin. But the catch here is that these drugs cost more than 3,000 dollars for a complete dosage – something beyond the means of the Manipuris seeking free ARVs.

”Apart from the high cost of drugs to kill the virus, hepatitis-C also calls for close medical supervision because it seriously reduces the body’s ability to fight off any infection and this includes opportunistic infections like tuberculosis which may also be present,” Singh told IPS.

HIV treatment involves the use of a cocktail of ARV drugs that cannot rid the body of the virus but inhibit its replication and delay deterioration of the immune system, reducing morbidity and extending life by several years.

But in resource-strapped developing countries, most of them with deficient public health delivery mechanisms, provision of free or subsidised ARVs has largely remained a dream although the World Health Organisation (WHO), in 2003, deemed poor access to the life saving drugs a global public health emergency.

WHO then evolved its ”3 by 5” programme and set a global target of getting three million people under ARVs in developing and middle income countries, including India, by the end of 2005.

India, which has a vibrant generic pharmaceutical industry, quickly came up with a highly potent but affordable ARV drug regimen that was accepted by WHO in the face of protests by transnational pharmaceutical giants.

But the cheaper drugs developed by Indian pharmaceutical companies benefited countries to which they were exported rather than HIV patients in India where free provision of ARVs using cheap generic drugs was introduced only in April 2004 after intense lobbying by networks of HIV-positive people and voluntary agencies.

There are now fears that following India’s acceptance of WTO rules, the generic drug industry would be crippled and the costs of quality ARVs would skyrocket leaving those with HIV in the lurch.

”We are waiting to see how all this will work out for people affected by HIV in Manipur. It is pretty obvious that funds will urgently have to be found for the large number of people who are dying from co-infections of HIV with hepatitis-C,” said Kripa Society’s Hijam Dineshwar Singh.