Wednesday, February 6, 2019

Hepatitis B and Hepatitis C Program should be integrated with National AIDS Control Program

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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