By Shyam Waikhom
IMPHAL, January 8: Due to lack of awareness on Hepatitis-C, the infection rate has increased even among the general population in Manipur. This assumes great significance as till now the Union and state governments have no proper treatment guidelines and preventive measures to control the onslaught of this dangerous disease.
Moreover, there is no proper survey data of people living with Hepatitis-C and its mortality rate in Manipur. The condition is so moving that people living with Hepatitis-C consider themselves waiting for their last breath. They have no hope of recovery and many lives have been lost due to co-infection of HIV and Hep C.
In an exclusive interview with people living with the disease at the office premise of Community Network for Empowerment (CoNE), it was found that there are no specific programmes for them being taken up by the responsible authorities of the state and Central governments. In comparison, there is second line treatment available for People Living AIDS. Hepatitis – C is considered more dangerous than HIV/AIDS and its chances of transmission are very high as the virus can survive for more than seven days in the open atmosphere.
Patients infected with Hepatitis – C said the information about the epidemic is very less and the awareness campaign and treatment guidelines for its prevention being taken by concerned authorities like the National Aids Control Organisation, Manipur AIDS Control Society and state health department are found to be insufficient.
In his honest confession a patient said that since super specialist doctors are not available, he and other patients have hesitation in taking the vaccination and suspect whether the treatment is capable of saving their lives or not.
Interferons injection and Ribavirin tablet are to be taken in combination for treatment of this disease. There 6 genotypes among them, genotype 1 and 4 requires injection for 48 weeks and genotype 2and 3 for six months regularly.
The advantages and disadvantages of the treatment is that interferons may cause transient bone marrow suppression resulting in reduced white blood cell and/or red blood cell counts (leucopenia and anemia, respectively). Ribavirin particularly may cause destruction of red blood cells (hemolysis) in people with kidney failure. Ribavirin also accumulates in the testicles and ovaries and causes birth defects.
Response to treatment is higher in acute hepatitis infection than chronic infection. However, many experts prefer to hold off treatment for 8-12 weeks to see whether the patient eliminates the virus without
treatment, according to reports.
Combination antiviral therapy with interferons injection and Ribavirin tablet has been the mainstay of hepatitis C treatment, said one of the patients.
Unfortunately, interferon is not widely available globally and it is not always well tolerated. Some virus genotypes respond better to interferon than others, and many people who take interferon do not finish their treatment. This means that while hepatitis C is generally considered to be a curable disease, for many people this is not a reality.
He further mentioned that treatment is very expensive costing upto Rs 7/8 lakhs but now it has decreased a little to Rs 4 lakhs without testing charges and totaled approximately around Rs 5 lakhs for treatment. This is an unaffordable amount for many poor persons.
Now, Hepatitis-C testing is mandatory for starting ART treatment though there is no consultant advice for the Hept-C patients except the suggestion for relinquishing alcohol and pork. A little hope was lighted when Ram Muivah as principal secretary of health announced the state illness fund that have a reimbursement policy of upto a maximum of Rs 1.5 lakhs.
The question is how far this small provision under this scheme has been successful in Manipur. Recently there was no positive response for reimbursement for a case of Hept-C treatment even though the documents had been submitted three–four months back.
According to the Rastriya Ayoghieya Nidhi a central sponsored scheme this is a total discrimination and against the persons with the disease as the treatment of government employees can be reimbursed very easily.
Here, Pharma companies must not play monopoly in medicine sale and accordingly in treatment and diagnostic process. The government should take some initiatives for the people with Hept-C because this is also a health issue. If the government continues to show disparity then the lives of the patients will be affected. The needs of the hour is to include patient with ART card for the state illness fund, provide latest investigation and comfortable testing equipment, awareness campaign by the concern authority, an expert advisor or counselor for Hept-C in the ART or ICTC centre. If the government does not contain the spread of Hep-C in time, it can become the most dangerous epidemic disease, far worse than HIV/AIDS.