1. HIV
HCV
HIV- HCV
The Killer Twins
Neeraj Mahajan 2009 1

2. HIV & HCV- What’s Common ?
This is the story of two infectious diseases – HIV and Hepatitis C i.e. HCV.
Both have many things in common…
Both are merciless & silent killers posing several difficulties in detections and
no cure in sight…
Both are SMART viruses – masters in the art of deception & disguise
They cripple the body’s defenses before silently causing maximum damage
deep inside…
We might call them the killer twins…
But before we begin let’s get few thing clear…
Neeraj Mahajan 2009 2

3. HIV & HCV- Basic Issues
HIV Virus
• HIV is not the same as AIDS.
• HIV= Human Immunodeficiency Virus
• HIV leads to AIDS or Acquired Immunodeficiency Syndrome, also
called Slim Disease.
• HIV is the virus that causes AIDS.
Neeraj Mahajan 2009 3

4. HIV: Not Just A Disease…But Series of Medical Complications
HIV may lead to many other secondary infection
• Bacterial- Tuberculosis (TB), MAC, bacterial pneumonia and septicaemia
(blood poisoning)
• Protozoal diseases such as toxoplasmosis, microsporidiosis,
cryptosporidiosis, isopsoriasis and leishmaniasis
• Viral- Kaposi Sarcoma, Herpes, Influenza (flu)
• Parasitic- Pneumocystis carinii
• Fungal- Candida, Cryptococcus, PCP and penicilliosis
• Malignancies such as Kaposi's sarcoma, lymphoma and squamous cell
carcinoma.
• Gastrointestinal malignancies -including pancreas cancer, breast cancer,
and skin cancer
Most of these are diseases that a normal person could easily fight off but may prove fatal for an
HIV infected person because of weak immune system
Neeraj Mahajan 2009 4

5. HIV-HCV : Why Serious Concerns for India
Both HIV & Hepatitis C or HCV are serious
concerns for India:
• Almost 0.7% of Indian population are HIV+.
• Close to 600 people are infected with HIV in
India every hour
• Approximately 630,000 people died from
AIDS-related illnesses in 2006.
• A World Health Organization report describes
HCV as a "viral time bomb".
Neeraj Mahajan 2009 5

6. HIV-HCV : Similarities
• Both are blood-borne diseases, caused by RNA viruses.
• Both are known to cause irreparable damage internally—till its too late.
• Both are such smart virus that manage to disguise their presence and not only
hood-wink the body's defense mechanism but also make it totally useless.
• There is no complete cure or vaccine for both HIV & HCV and none likely to come
out in the foreseeable future.
• Both HIV & HCV can be symptomless for a long time.
• Medications can only keep the infected people alive, longer and healthier. If a
patient misses even one dose, the virus may become resistant to the medicines
causing them to lose their effect. Even in patients who take every dose, the
medicines may stop working after some time.
• These drugs are very expensive and some of them are known to cause severe
adverse reactions.
Neeraj Mahajan 2009 6

7. HIV-HCV : Ignorance is not bliss !!
• Both HIV & HCV are smart and lethal invaders – masters in the
art of camouflage, deception and hidden combat. They do
their job after silently crippling the defenders – inside the
human body.
• According to a World Health Organization projection HCV
already infects approximately 180 million people worldwide.
Despite all this HCV remains a largely unknown disease in
India.
• While there are specific organization to control TB, Malaria,
Leprosy, or AIDS— there is no organization which is on a
lookout for HCV or has it on its preventive Health radar
screen—like HIV/AIDS and India is so far yet to declare a “High
Alert” against the killer HCV
Neeraj Mahajan 2009 7

8. HCV is many times more dangerous than HIV or AIDS
• Both HIV and HCV virus replicate at an alarming rate, inside the body.
While the HIV virus replicates anywhere between 10 billion new viral
particles per day. HCV produces even more nearly 10 trillion new viral
particles each day.
• HIV is a fragile virus which dies quickly outside the human body. HCV virus
on the other hand is a tougher virus which can live for days outside the
human body.
• According to WHO more than double i.e. against 5.1 million Indians
suffering from HIV, around 12 million have HCV. As many as half of all
people with HIV are likely to be co infected with HCV which is four times
more prevalent and ten times more infectious than HIV, which causes
AIDS. HCV or hepatitis C is known as "silent killer".
• Deaths from HCV are expected to triple in the next 10-20 years. The death
toll is likely to surpass that of AIDS and could reach more than a million
by 2020
Neeraj Mahajan 2009 8

9. Key Issue: How Do We Combat An Unknown Disease
• The issue is how do we fight against a disease we know little about?
• Already about 18 million people in India are estimated to be
infected with HCV— most of whom do not know they are infected.
• A quarter of them are likely to develop chronic liver disease in the
next 10 to 15 years.
• When treatment for Hepatitis C cost about Rs. 13,000 a week - or at
least Rs. 2 lakh for a six-month course— how many people can
afford to undergo treatment that too when they cannot be sure
that it will cure them.
• Can you imagine the cost when each Liver transplants costs about
$200,000 in the US and patients need expensive drug and other
treatments for the rest of their lives.
Neeraj Mahajan 2009 9

10. PROBLEM: Many medically undiagnosed people are walking the
on streets blissfully unaware of their HIV+ve status
The seriousness of this problem can also be assessed from the fact
that only less than 1 % population of India get themselves tested for
HIV-HCV even once in the lifetime and worst still up to 27 % HIV
infected people remain undiagnosed… It’s a world wide trend that
many HIV infected -- medically undiagnosed people are walking the on
streets blissfully unaware of their HIV+ve status. Such people continue
infect others while leading normal lives simply because–
• They do not have any visible or apparent symptoms of HIV/AIDS -
HCV
• They never felt the need to get tested
• It is not a fashionable for people to get HIV – HCV tests done, even
once a lifetime
• Stigma attached with going for a HIV test (what will people say!),
unless unavoidable
Neeraj Mahajan 2009 10

11. PROBLEM: They are like Human Time Bombs that can
explode any moment
• They are like potential Human Time Bombs that can explode
any moment causing irreparable damage by actually infecting
100s of other innocent and unsuspecting people.
• The moot question therefore is whether India can be left to
the mercy of these killer twins- HIV & HCV?
• This is not a just medical but human rights issue. An issue
concerning right to live and stay away from any accidental HIV
–HCV contamination
Neeraj Mahajan 2009 11

12. CORE ISSUE: Shortening the Window Period
• Another thing that both HIV & HCV share in common is the
window period i.e. the early stage of the infection when none
of the available tests can detect their presence.
• The incubation period of HCV infection is 2-26 weeks i.e., the
symptoms may take this much time to appear after a person
has been infected. It may take as long as 5-10 years for an
infected person to develop chronic liver disease after
exposure to the virus.
• Early and confirmed diagnosis of HIV/HCV – may prove to be a
turning point for better management of the infection besides
U-turn towards damage control and possible recovery.
Neeraj Mahajan 2009 12

13. Window Period: HIV Infection and Antibody Response
---Initial Stage---- ---------------Intermediate or Latent Stage-------------- ---Illness Stage---
Virus
Antibody
6 month ~ Years ~ Years ~ Years ~ Years
Neeraj Mahajan 2009 13

14. Window Period: HIV Infection and Antibody Response
Neeraj Mahajan 2009 14

15. HIV-HCV Window Period: Which segments of the
Society need to be Concerned?
• Defense Services, Police & Para- Military forces
• Blood Banks & Blood Transfusion Sector
Neeraj Mahajan 2009 15

16. HIV-HCV Window Period: Why should each segment of
the Society be Concerned?
Neeraj Mahajan 2009 16

17. HIV-HCV Window Period: Why should Blood Banks &
Blood Transfusion Sector be Concerned?
Neeraj Mahajan 2009 17

18. HIV-HCV Window Period: Why should IDUs, Prostitutes, Gays
and other High Risk Categories be Concerned?
Neeraj Mahajan 2009 18

19. HIV-HCV Window Period: Why should Doctors, Hospitals &
Other Healthcare Employees be Concerned?
Neeraj Mahajan 2009 19

20. HIV-HCV Window Period: Why should Pregnant Woman, New
Born Babies and other faceless Indians be Concerned?
Neeraj Mahajan 2009 20

21. HIV-HCV Window Period: 360 degrees of Circle of Concern
Neeraj Mahajan 2009 21

22. HIV-HCV Window Period: Rationale for National Awakening
Neeraj Mahajan 2009 22