A distant voice in the darkness

I have on several occasions referred to the longer-term threats to survival which face many people with AIDS in Indonesia. Perhaps the greatest threat will be caused by the high prevalence of viral hepatitis co-infection among those with HIV in Indonesia - probably as high as 50%. The effects of this co-infection will start to be felt early in the next decade, given the longer 'latency' of viral hepatitis.

Whereas there is an increasing number of treatments for HIV, treatment for hepatitis C seems to be stuck in a time warp, with still only two drugs available, both of which must used together, at unaffordable cost, with excruciating side effects, and having a very low success rate - less than 30% among co-infected people. But without this treatment, they will start to suffer liver failure, which (without liver transplants - again rarely accessible) will be fatal. It'll be like we're back in the 90's.

There are estimated to be more than 170 million people with chronic hepatitis C infection around the world, significantly more than the number living with HIV. So why do we only have two awful drugs to treat a curable disease, while we have more than 20 for HIV? Part of the reason is that the hepatitis C virus was identified several years after HIV.

But it is difficult not to draw the conclusion that there hasn't been the pressure. Prof Joep Lange, in his closing presentation at the recent HIV-NAT Symposium, made the point that we were very lucky that the HIV epidemic first became apparent among gays in America. If it had appeared as an affliction of poor black people in Africa, would there have been the same pressure to discover new drugs, to determine the cause. Surely, not! The parallel with hepatitis C is obvious.

Of course, there is a significant number of people with hepatitis C in the West. But they are not a homogenous group; indeed, many of them are 'junkies' (since hepatitis C spreads among injecting drug users in the same way as HIV, just ten times more easily - 90% of such drug users in Indonesia have hepatitis C). But also people are not (yet) dropping dead with the disease, and particularly not at such an early age as they did in the early 80's with HIV.

The message is clear: we need much, much more activism to press for development of new drugs - and a vaccine - for hepatitis C infection. Sadly the voices are very muted.

Babé