Liver problems

Since most of the people with HIV (PLHIV) I meet were infected through sharing needles, most of them are co-infected with hepatitis B and/or C (HBV/HCV). These nasty viruses, which are spread in much the same way as HIV, usually take longer to cause problems. Before antiretroviral therapy (ART) became widely available, most people died of AIDS before hepatitis made itself felt. But now, thanks to ART, they are living long enough to start worrying about surviving their other virus(es).

We've done quite a good job of providing treatment for HIV, but we're a long way behind on drugs for HBV and HCV. I'll talk some other time about hepatitis B, but for hepatitis C, the picture is awful.

First, cost. As one liver doctor here told Anne Mijch, to diagnose hepatitis C costs the same as buying a motorbike; to treat hepatitis C costs the same as buying a car. (From the Jakarta roads, seems like every Indonesian can afford a motorbike - and all of them are riding them at the same time!). The side effects of treatment are also horrible - and last for the full year of treatment. And at the end of all that, if you're co-infected you'll be very lucky to be cured - the chances are less than 30%.

Of course, for treatment at that price, there's no shortage of people touting it. And of course they don't dwell too much (at all?) on either the lousy side effects or the lousy cure rate.

But for most, treatment for hepatitis C is only a dream. We try to tell them that they're lucky, because better and cheaper and easier to tolerate drugs may appear in time. But at the moment this is also an empty dream; there's no end of candidates, but few that offer much real hope in the next ten years.

Because most of the folk we support were infected in the last five or six years, we aren't yet feeling the effects. I'm scared that in around five years time, it's going to be like we're back in the pre-ART days, with people dying of liver failure instead of other opportunistic infections. Of course, they may die of a motorcycle accident before that!

Babé