Tackling the Hepatitis C Disease Burden in Punjab, India

Abstract

Hepatitis C virus (HCV) is a globally prevalent pathogen and is a major cause of healthcare burden in India. HCV poses a significant problem in the state of Punjab, India owing to the higher prevalence of risk factors like unsafe medical practices (including unsafe injections and dental procedures) and intravenous drug use. The reported prevalence of HCV in this part of the country was 5.2% in 2012, while a recent study has shown the prevalence to be 3.2% in 2016. Similar to the other geographic belts in India, genotype 3 predominates in the state of Punjab. Control of HCV infection in Punjab requires focusing on several strategies. There is a need to formulate a health educational curriculum targeting not only the high-risk population but also the general population regarding the transmission of HCV. Training of family physicians who form the first link to patients in the community is imperative in the success of healthcare programmes. Adopting the dual approach of treating the old cases (decreasing the reservoir pool of HCV) and decreasing the incidence of new ones would help curtail the disease and decrease liver related mortality. A commendable initiative has been launched by the Punjab state government to eliminate HCV from Punjab. However, besides the initiative by the government, a concerted effort by all other stakeholders in managing the HCV burden in India, namely the doctors, the drug companies and the nongovernment organizations is required for control of HCV. ( J CLIN EXP HEPATOL 2016;6:224-232) H epatitis C virus (HCV) is a single stranded RNA virus belonging to the family Flaviviridae. It has six major genotypes 1-6 with genotype 1 being the most prevalent genotype globally (46%), followed by genotype 3 in 22% and genotype 2 and 4 in 13% each.

Distribution of hepatitis C genotypes in Uttar Pradesh, India; rare genotype 4 detected

“…According to the current study HCV GT3a (68.07%) and GT1a (25%) were predominant GTs circulating in UP, North India. The findings were in concordance with previous studies conducted in other states of north India, for example, Delhi, Haryana, and Punjab . The current study, reported HCV GT4a, which was not earlier reported from UP, India.…”

Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

“…25 Communitybased seroprevalence studies have mostly reported similar results, 26,27 but in some areas such as Punjab state, higher prevalence of 3·2-5·2% has been reported. 28,29 In a survey of 14 481 people who inject drugs, the weighted anti-HCV prevalence was 37·2% (including 13·2% with HCV-HIV co-infection), varying from 4·9% to 64·9% across 15 Indian cities. 30 Indirect evidence suggests that most cases of HCV infection are related either to unsafe injection practices or transfusion of contaminated blood or blood products before the introduction of mandatory testing of donated blood.…”

Clustering of hepatitis C virus antibody positivity within households and communities in Punjab, India

“…We were unable to correct the overall prevalence estimate to account for the prevalence among these populations due to a lack of data. A cross-sectional serosurvey asking about recent behaviours cannot accurately capture the effect of lifetime medical exposures and injections with contaminated needles, which are important factors associated with HCV prevalence in India, South Asia and globally [15, 34]. The receipt of medical injections is very common in this population, with around 35% of the sample having received one in the previous 6 months.…”

“…Previous studies suggest low socio-economic status (S-ES) is associated with increased HCV infection risk from healthcare exposures, such as re-use of syringes [14], which is a common practice in neighbouring Pakistan and has also been identified as a risk factor associated with increased odds of HCV in Punjab, India [15]. A combined, continuous S-ES score variable was created to increase power and better capture S-ES than individual variables.…”