March 17th – 3rd day. Meeting Professor Hamid Saeed

We took a taxi to the Aga Khan University. I knew I had an appointment with Professor Saeed Hamid from the GI department, but I did not have any opportunity to check my emails to find out what time…..so we turned up at 3 and hoped for the best! Luckily he had time to see us for a short time…..but wow! Did we learn a lot about Hepatitis C in Pakistan in that short half hour!

Professor Saeed Hamid is a renowned researcher in the field of Hepatitis C in Pakistan. He has produced a wealth of research and he has spoken at numerous seminars to increase awareness about this disease.

In Pakistan 79% of people are Genotype 3a. 8% Genotype 3b. This is the esiest Genotyp to kill with treatment, but I wanted to speak to him about how expensive the treatment is. He told me some news which surprised me. He told me that they use a Generic Interferon which costs them only 8 000 Rupees (£80) per month. This is hugely cheaper than the branded Interferon which costs 12 000 Rupees per injection (£120). The dosing they use is standard (not Pegylated Interferon) 3 million i.u. 3 x pr week and weight based Ribavarin.

I asked him about how it is passed on in Pakistan. Therapeutic Injections are given for all sorts of conditions, and the injections given maybe vitamins or antibiotics. A piece of research carried out by Aga Khan showed that of people who had 5 or more injections in last year 10% have Hepatitis C. The other way is bblood transfusions. 50% of blood banks use professional blood donors, who may well be drug addicts. The blood is most frequently tested for HIV, because funding is provided by UNAID, even though Pakistan is a country with low prevalence of HIV, but only 25% is tested for Hepatitis C. And in Pakistan people will ask for blood transfusions for conditions such as ‘General Malaise’. Another common practice is for families to give blood transfusions to other members of the family, completely untested. In this way the pattern of familial transmission is occurring. He also highlighted the huge problem that exist with unsterile practices in dentist’s.

There has been a huge growth in hospital admissions due to Hepatitis C. At present this is running at about 10% of ALL hospital admissions at the Aga Khan hospital.
Overall in Pakistan the prevalence is thought to be 6%, however in some periurban areas the prevalence is as high as 20%.