Hepatitis-C Virus Hinders HIV Therapy in India's Northeast

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Hepatitis-C Virus Hinders HIV Therapy in India's Northeast

Ranjit Devraj

IMPHAL, India, Mar 14 (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

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. (END/2005)

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