# #soropositivoorg : Thai activists call for treatment for hepatitis C for people with HIV

- Link: https://soropositivo.org/soropositivoorg-thai-activists-call-for-treatment-for-hepatitis-c-for-people-with-hiv/
- Published: 2010-08-13T09:47:54-03:00

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**AVISO IMPORTANTE**

Este texto é informativo e não substitui avaliação médica. Eu escrevo também a partir
da minha experiência como paciente, mas decisões sobre exames, diagnóstico e tratamento
devem ser tomadas em conjunto com profissionais de saúde.

**HÁ VIDA COM HIV**

Este blog está online há 26 anos, 3 meses e 6 dias.

###### 󠀁[Hepatitis C treatment](http://www.aidsmap.com/cat/1632/)󠁿

Carole Leach-Lemens

 Treating co-infection of HIV and hepatitis C (HCV) in Thailand makes sound economic
sense, Noah Methany argues in a policy paper published by the Thai AIDS Treatment
Action Group (TATAG) on July 28, 2010, in recognition of World Hepatitis Day. Outlining
the public health crisis of HIV and HCV co-infection faced by people who inject 
drugs in Thailand, the paper makes recommendations to the government to help stop
and reverse this dual epidemic. While Thailand boasts a universal health care system
that claims healthcare for all without discrimination, people living with HIV who
are co-infected with HCV, notably current or former drug injectors, face unique 
barriers to effective treatment, notes the author. Increased access to antiretroviral
treatment in low- and middle-income countries has increased life expectancy and 
improved the quality of life of people living with HIV. But many find they are now
dealing with other chronic health problems, of which hepatitis C is one. Hepatitis
C, a blood-borne viral infection, spreads easily through the sharing of injecting
equipment, and disproportionately affects injecting drug users (IDUs). HCV is transmitted
when infected blood from one person enters another’s bloodstream through any kind
of contact. Unlike HIV it can live outside of the body for a long period of time,
making it ten times more infectious than HIV, notes Methany. HCV is the world’s 
leading cause of liver disease. It can progress silently from fibrosis (mild scarring
of the liver) to cirrhosis (severe scarring). Those with cirrhosis are at increased
risk for liver cancer and liver failure. People living with HIV have weakened immune
systems so HCV progresses more rapidly than in people who are HIV-negative. End-
stage liver disease is becoming a growing cause of death among people living with
HIV. Additionally, Methany notes, “HCV complicates a person living with HIV’s treatment
because it can triple the risk of antiretroviral-associated liver toxicity.” There
is a general lack of awareness of the disease amongst the medical community as well
as those at risk. Diagnosis, management and treatment are complex and costly and
are considered the main barriers to improving access to treatment. “It is incredibly
ironic that we have dramatically altered the prognosis for HIV – a currently incurable
disease – only to see co-infected people dying from complications of hepatitis C,
a disease that we can cure,” noted Tracy Swan of New York’s Treatment Action Group,
the paper’s editor. IDUs may also have to face other problems when trying to access
health care that include denial of, or discriminatory treatment and a lack of confidentiality.
WHO estimates that three percent of the world’s population or 180 million people
have been infected with HCV, with an additional three to four million newly infected
each year, many of whom remain undiagnosed. WHO estimates 32.3 million people living
in South East Asia are infected with HCV. An estimated two to nine million IDUs 
are living in the Asia-Pacific region, of which 750,000 are estimated to be living
with HIV. While there are few epidemiological studies on the prevalence of HIV and
HCV co-infection in Asia, an estimated 60-90% of IDUs are living with HIV. According
to WHO and UNAIDS 610,000 Thais are living with HIV/AIDS; 5 to 10% are estimated
to have got it from injecting drugs and at least half of all injecting drug users
in Thailand are living with HIV/AIDS. The International Harm Reduction Association
estimates up to 90% of injecting drug users in Thailand have become infected with
HCV, notes Methany. A two-step process is required to determine infection with HCV.
The first part-an antibody test shows if a person is or has been infected. A viral
load test is then needed to determine whether infection is chronic or not. Liver
enzyme levels are needed to monitor people with HCV. Length of treatment is determined
by genotypic testing. Methany notes that while there are at least six different 
genetic versions of hepatitis C virus, genotypes 1,3 and 6 are the most common in
Thailand. A three to twelve month course of treatment with a combination of two 
drugs – pegylated interferon (PEG-IFN) and ribavirin (RBV) – is the current standard
of care. While generally there is a 50% treatment success rate, response varies 
and is related to genotype. Ribavirin is available as a generic product, whereas
the two versions of pegylated interferon are still under patent. The current costs
of treating hepatitis C is approximately US $38,000 for a 48-week course of treatment,
prohibitive for many health care systems. In Thailand these drugs are not on the
Thai National Essential Drugs List and so are not included in the Thai universal
coverage scheme. Contrary to arguments that treating HCV and HIV co-infection in
Thailand is too expensive, the author cites two studies that showed treating people
with ribavirin and pegylated interferon to be cost-effective and increased life 
expectancy. Researchers showed that treating Thai HCV (genotypes 2 and 3) patients
compared to no treatment resulted in a lifetime cost saving of 556,862 baht (US$
16,784). Noah Methany argues that not only is it Thailand’s constitutional and moral
obligation to provide treatment for Thai HCV patients but it also makes economic
sense. Methany proposes the following policy recommendations to address the challenges
faced by Thais, current or former injecting drug users, who are co-infected with
HIV and HCV.

 * Immediately scale up of evidence-based harm reduction programmes that promote
   access to clean injecting equipment/sterile syringes, which prevent new HCV infection.
 * Increase support for Thai civil society involvement in HCV awareness campaigns
   through promotion of capacity building and education of advocates, patients, 
   healthcare providers and policymakers.
 * Provide universal access to free testing for HCV and offer follow-up diagnostic
   tests on a routine basis to IDUs who test positive for HIV.
 * Provide national level data collection on HCv incidence and prevalence among 
   Thais living with HIV/AIDS.
 * Include pegylated interferon and ribavirin on WHO and Thai Essential Medicines
   List.
 * Develop Thai-language national guidelines based on international best practices
   for HCV treatment and care.
 * Increase political support for the Thai Government Pharmaceutical Organization(
   GPO) to produce generic versions of pegylated interferon and ribavirin, and
 * Increase political support for Thai government officials to exercise legal, TRIPS
   flexibilities (such as compulsory licences and parallel importation) to gain 
   access to cheaper HCV treatment.

### Reference

 Methany, N and Swan, T (ed) _Illuminating a hidden epidemic: the public health 
crisis of HIV/HCV co-infection among injecting drug users (IDU) in Thailand_. Thai
AIDS Treatment Action Group (TTAG) Foundation, July 28, 2010. [www.ttag.info](http://www.ttag.info/)

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