The New AIDS Fight -- Don't Forget This Infectious Killer

"AIDS deserves our attention. But so, too, does another developing disease, one that in the developing world is even more widespread than AIDS -- hepatitis.

"... While aggressive testing and prevention programs have slowed HIV transmission rates in some countries, the spread of hepatitis in the developing world continues unabated. In Uganda, for instance, HIV infection rates have diminished greatly because of public health programs that encourage safe sex practices. The prevalence of HIV there has declined from 30 percent of Ugandans in 1992 to 5 percent in 2002.

"Over the same period, however, the rate of hepatitis B remained steady, and is now found in 12 percent to 15 percent of the population, three times the number infected with HIV. The true extent of hepatitis C in Uganda and the rest of Africa is still unknown because testing, though common for more than 10 years in the United States, has not yet become readily available in developing countries.

"The lack of testing and treatment means that the disease will continue to spread as the infected unwittingly pass it on to their sexual partners, newborns and to hospital patients via blood transfusions. In the case of hepatitis B, the virus can be spread through living with an infected person.

"Fortunately, it is possible to treat, and sometimes cure, people with hepatitis B and C. For that to happen in the developing world, however, testing must be made inexpensive, readily available and reliable. Seeing to it that tests are available at blood banks will lead to a reduction in hepatitis C transmission, as has been the case with HIV and hepatitis B. Focusing on infected sex workers and pregnant women would be a cost-effective way to cut down on the transmission rates. Some drugs being used in Africa against HIV can also be used against hepatitis B. Treating HIV without at the same time diagnosing and treating hepatitis B or C co-infection is foolish.

"The push for hepatitis B vaccination is beginning in Uganda and elsewhere; the bad news is that there is not yet a vaccine for hepatitis C. Until such vaccines are widely available, hepatitis, as well as AIDS, deserves the world's attention."

Ocama is a specialist medical officer at Makerere University Teaching Hospital in Kampala, Uganda. Lee is a professor of internal medicine at the University of Texas Southwestern Medical Center-Dallas.

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