India has the world's
third largest number of people with HIV, next to South Africa (7.1 million) and
Nigeria (3.2 million). As per HIV Estimations 2017 report, India has around
21.4 lakh people living with HIV (PLHIV) with adult prevalence of 0.22% vs 3.2%
in Nigeria vs 18.8% in South Africa.
India has a National AIDS
Control Programme (currently NACP IV) since 1992, when NACP I was launched and
the National AIDS Control Organization (NACO) was constituted to implement the
programme.
The main objective of NACP IV
is to reduce new infections by 50% (2007 Baseline of NACP III) and provide
comprehensive care and support to all persons living with HIV/AIDS and
treatment services for all those who require it.
The HIV Estimations 2017 has
acknowledged the significant impact of the National AIDS Control Programme on
new infections and AIDS-related deaths. There has been more than 80% decline in
estimated new infection from peak of epidemic in 1995 as well as 71% decline in
AIDS-related deaths since its peak in 2005.
However, challenges still
remain.
One such challenge is co-infection with hepatitis B and hepatitis C viruses. Important
thing is prevention of AIDS should also reduce isolated cases of hepatitis B
and C.
This is of public health
concern because HIV and viral hepatitis coinfection can complicate the
management of HIV infection. Also, progression of liver disease to cirrhosis
and hepatocellular carcinoma is faster in co-infection; moreover, they may not
respond well to treatment. Mortality is higher in these patients.
HIV, hepatitis B and hepatitis
C have similar routes of transmission. They spread by contact with
infected body fluids such as blood, semen and vaginal fluid or sexual
contact with an infected person or via injection drug use (sharing
contaminated needles, syringes) or from a mother to her baby
during pregnancy or delivery. Needle stick injuries or exposure to
splashes of blood are major routes of hepatitis B transmission.
Because of these shared routes
of transmission, people at risk for HIV infection are also at risk for
hepatitis B or hepatitis C infection and also vice versa.
Of the three blood-borne
viruses (Hepatitis B, hepatitis C and HIV), hepatitis B is the most infectious.
The HIV virus lives for 24 hours in dried blood at
room temperature. Hepatitis C virus can survive on environmental
surfaces for up to 16 hours. It can also spread from infected fluid splashes to
the conjunctiva.
The hepatitis B virus can
survive in dried blood on floors and tables at room temperature for up to 7
days and remains capable of causing infection. Hepatitis B is therefore a more
dangerous infection than HIV. Preventing hepatitis B will also prevent HIV.
The government launched a
National Viral Hepatitis Control Program for the prevention and control of
viral hepatitis in India. With this program, India aims to eliminate Hepatitis
C by 2030 and achieve significant reduction in the infected population,
morbidity and mortality associated with Hepatitis B and C (cirrhosis and
hepatocellular carcinoma).
Instead of a separate national
program for viral hepatitis (hepatitis B and hepatitis C), it should be integrated
with the National AIDS Control Program. There can be a
separate program for hepatitis A, which can also be made a part of National
Diarrheal Diseases Control Program again because of shared routes of
transmission.
The budget allocation for NACP
should also incorporate the allocated budget for viral hepatitis.
The barrier method of
contraception (condom) should also be a part of this program as they protect
against STIs including HIV.
Take home points
· Prevention
of hepatitis B (and C) also means prevention of AIDS.
· AIDS
prevention with condoms is also linked to prevention of unwanted pregnancies.
· Hepatitis C
is curable; hepatitis B and HIV are manageable.
· One national
health program with common budget should handle both the prevention and the
treatment.
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical
Associations in Asia and Oceania
(CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA
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