Hepatitis – HIV- TB

Hepatitis

Hepatitis is a major health problem around globe with high morbidity and mortality. Approximately 400 million people are living with viral hepatitis worldwide (WHO, 2015). Viral hepatitis is responsible for 1.4 million deaths per year and it is the 7th leading cause of death around globe. The combined mortality from hepatitis B and hepatitis C exceeded the mortality by HIV, Tuberculosis and Malaria in 2014 (Global Burden of Disease Report 2014 by Naghavi et al).

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225 People will die from hepatitis in the time it takes to play a game of football (World Hepatitis Alliance, 2016)

Hepatitis is a major health problem in Pakistan. About 5 million people have Hepatitis B and 10 million people have hepatitis C infection in Pakistan. Our systematic review showed that the prevalence of Hepatitis C is 4.9% in general population, 57% in people who inject drugs and 48.67% in multitransfused population (Waheed Y et al., 2009). Pakistan has the second highest burden of Hepatitis C in the world.

The viral hepatitis remained underestimated for several years. Recently, global community recognized the high global burden of Hepatitis and included it in the Sustainable Development Goals by United Nations (United Nations, 2015). World Health Organization is also finalizing its draft for global hepatitis strategy [2016-2021], the draft was discussed in WHO Executive Board meeting in January 2016 and will be approved by World Health Assembly in May 2016 (WHO, 2015; World Hepatitis Alliance 2016).

In Pakistani population, Hepatitis awareness is very low. People have some basic knowledge about hepatitis but they do not know about the major risk factors involved in hepatitis transmission. In our recent study to evaluate the Hepatitis B & C awareness in university going population of Rawalpindi and Islamabad cities, we observed only 28% of university students knew that HBV/HCV can be transmitted by dental instruments and ear/nose piercing (Waheed Y unpublished data). People do not have any idea of vaccination, large community of barbers of Rawalpindi/Islamabad think that the Interferon treatment is vaccine for Hepatitis (Waheed Y 2010).

It is presented in American Association for the Study of Liver Disease (AASLD) meeting in San Francisco [Nov 2015], that only 85,000 [~1%] of Hepatitis C positive patients are taking treatment each year in Pakistan and only 100,000 [1%] new Hepatitis C cases are diagnosed each year (Hamid S. et al., 2015). In order to combat Hepatitis by 2030 and achieve the targets in Sustainable Developments Goals, Pakistan must increase the Hepatitis diagnosis and treatment to at least 5% of hepatitis positive patients each year. Majority of Pakistani people do not have the health insurance coverage and most of the health financings are out of pocket payments. There is strong need to speed up the hepatitis screening, as majority of Hepatitis positive patients are unawares of their positive disease status.

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Time is running out; eliminate hepatitis now (World Hepatitis Alliance, 2016)

 

If the proper attention were not given to the control of hepatitis, experts have forecast that the 20 million deaths will be occurring by Hepatitis B only from 2015 to 2030 (WHO, 2015). Hepatitis associated morbidity and mortality can be reduced by 2030 by increasing diagnosis and the number of individuals getting higher efficacy treatment (Editorial Lancet, 2015).

The control of hepatitis pandemic requires political will, financial investment, and support from pharmaceutical, medical and civil organizations around the globe (Waheed Y. 2015).

Hepatitis C in Pakistan

Challenges in Hepatitis Eradication

 

HIV/AIDS

Fifteen years ago AIDS epidemic was affecting families, communities and entire nations. The epidemic united the global community and the efforts were initiated to decrease the AIDS death toll and increase HIV drugs accessibility. Millennium development goal six played key role in the success against AIDS epidemic.

With the combined efforts from global community AIDS epidemic is halted and reverse. If the efforts are stopped here the AIDS linked morbidity and mortality will again start growing. Massive success has been achieved during last 15 years (2000-2015) in the fight against HIV/AIDS. The targets for 2030 are very exciting (Table 1, Source UNAIDS). Let’s not stop here and end HIV epidemic by 2030.

 

Table 1: Fifteen years of progress and hope. But miles to go to end the AIDS epidemic by 2030 (UNAIDS).

2001 2014/2015 2030
People Living with HIV on Antiretroviral Therapy 1 Million 15 Million ALL People living with HIV
New HIV Infections 3 Million 2 Million 0.2 Million
AIDS-related Deaths 2 Million 1.2 Million 0.2 Million
Investments for AIDS Response 4.9 US$ Billion 21.7 US$ Billion 32 US$ Billion
New HIV Infections Among Children 530,000 220,000 <50,000
HIV Awareness Among Young People 25% 35% >90%
Children Orphaned due to AIDS 14.4 Million 13.3 Million 0 more orphans, all orphans cared for and well
Cost of Antiretroviral Medicines 10,000 US$ 100 US$ First line regimens 100 US$ All available regimens
Life Expectancy of a person living with HIV +36 Years +55 Years Same as others
TB related AIDS Deaths 520,000 348,000 0
Travel Restrictions 59 Countries 37 Countries 0 Countries

 

Pakistan is among few Asian countries in which new HIV cases are increasing year by year since 1990. There are 94,000 cases of HIV in Pakistan and only 14,000 are registered with government. There are 21 HIV treatment centers and 20 community based care & support centers for HIV patients across country. The government is planning to increase the treatment centers from 21 to 25 till 2017.

The main source of HIV infection in Pakistan is use of contaminated injection equipment among people who inject drugs (PWID). The overall prevalence of HIV among PWID in Pakistan is 17%. There are five cities in Pakistan having HIV prevalence of more than 40% in PWIDs. These cities include Sargodha (40.6%), Karachi (42.2%), Gujrat (46.2%), D.G. Khan (49.6%) and Faisalabad (52.5%). The PWIDs involved in sexual activity with MSM, HSWs, and FSWs are also transmitting HIV infection to key populations.

Tuberculosis

Pakistan is ranked 5th among 22 high burden TB countries and 4th among countries where MDR-TB has become serious challenge for clinicians.

Pakistan has TB prevalence, incidence and mortality rates of 341, 270 and 26 cases per 100,000 populations respectively (Global TB Report, 2015). The Millennium Development Goals targets for TB mortality were achieved while TB prevalence and incidence targets were missed by the country. The percentage of MDR-TB is 3.7% and 18% in new and retreated patients respectively.

Research

Bridging Health Foundation will provide research platform for key health issues and targets in sustainable development goals. The foundation will help and finance smooth conduction of research projects including research on key health problems of Pakistan like Hepatitis, Tuberculosis etc.