Although viral hepatitis, primarily hepatitis B and C, continues to cause 1.5 million infections worldwide each year, according to the World Health Organization (WHO), It could reduce deaths by 90% and reduce deaths by 65% by 2023. All types of hepatitis are capable of inflaming the liver and causing more serious disease at the same time: in fact, the World Health Organization estimates that 78% of hepatitis cases primary cancer In the liver, 57% of cases of cirrhosis are caused by hepatitis.
In this sense, Spain is one of the best examples in the world of eliminating one of the most dangerous forms of hepatitis: hepatitis C.Give us an idea, hepatitis C dropped sharply, three to four times lower than hepatitis B, It affects between 0.4% and 0.7% of the population living in Spain. In my country, the autonomous regions of Galicia and Andalusia are prominent in the fight against this disease.
In fact, Galicia is becoming a pioneering region in the world by conducting extensive testing in the population. In this sense, the Spanish Alliance for the Elimination of Viral Hepatitis (AEHVE) believes that: Could be the first community to eliminate hepatitis C by 2024. Experts from AEHVE and the Spanish Digestive Foundation (FEAD) therefore urge other autonomous communities to adopt a similar strategy.
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Hepatologist and FEAD president Marta Casado warns that liver disease only occurs when it is very severe and irreversible. Therefore, implementing widespread testing is critical to uncovering undetected cases before it is too late. In addition, it stresses that vaccination is key in the fight against hepatitis in Spain, Healthy habits play key role in avoiding most common liver diseases: Alcoholic liver disease and fatty liver.
How did Spain’s hepatitis C strategy achieve such good results?
Spain is currently one of the countries best placed to achieve elimination of hepatitis C, thanks to measures at the national and regional levels. All this has resulted in a very high rate of treatment of infected patients in Spain, thanks to the great efforts of the relevant professionals, patients and medical associations. They also initiated local projects aimed at increasing the number of patients subsequently treated.
Is it possible to eradicate hepatitis C? What challenges does this goal present?
With hepatitis C, we’re talking about elimination, not eradication. We won’t be able to achieve eradication of hepatitis C because we don’t have a vaccine for it, but there is no doubt that we will achieve eradication of hepatitis C in the next few years. To achieve this goal, we face a series of challenges. Improving diagnostic yields is one of the most important factors: many patients who are infected with the hepatitis C virus are unaware that it is an asymptomatic infection.
A universal screening strategy is necessary so that all adults in Spain are tested for hepatitis C at least once in their lifetime. Other challenges include implementing hepatitis C elimination efforts among vulnerable groups such as injecting drug users, and developing regional plans for hepatitis C elimination, as in Galicia and Andalusia, so that there is a unified strategy for the entire national territory.
What is the reason for the low diagnosis rate of this disease?
As a hepatologist, I always tell my patients that the liver is a very dangerous organ because it is asymptomatic, has no nerve endings, and therefore cannot be injured. No symptoms are observed until an advanced and irreversible stage when organs stop working. Patients do not know they have the disease, making it difficult to diagnose everyone. This happens with hepatitis C as well as with other liver diseases, which is why special efforts must be made to treat each individual.
Are we asking our doctors enough about our livers?
Unlike the brain or the heart, the liver is an abandoned organ that is rarely talked about, including its diseases. Patients are likely to be rarely consulted for liver disease, and liver disease diagnosis is usually based on the analysis of changes. Therefore, it is very important that adult patients go to a health center for hepatitis B and hepatitis C assay analysis.
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Considering that most STDs are on the rise, isn’t there more transmissibility being observed through the hepatitis B channel?
True, hepatitis B is transmitted sexually or through contaminated blood, but we have an effective vaccine that has been part of the Spanish vaccination calendar for almost 30 years. For this reason, the population aged 30 or even slightly older in our country has all been vaccinated. Vaccination campaigns are also carried out among adolescents, and a large population is vaccinated, which means that while there is a risk of sexual transmission, the rate of transmission is low because the vaccine is so effective.
It is true that around 2008 we saw an increase in the incidence of hepatitis B in Spain, but this was related to immigration from countries where hepatitis B was endemic. Spain is considered a low-prevalence country for this type of hepatitis, with a prevalence of between 0.5% and 0.8%, with approximately 200,000 or 300,000 people infected with the virus.
Under what circumstances are we more susceptible to hepatitis?
It depends on the type of hepatitis. When we talk about virus types, there are B, C, and Delta viruses, which are transmitted parenterally, that is, through contact with an infected person’s blood or other bodily fluids, risky sexual relations, or use of drugs. Sharing syringes or needles is the most common route. Still other viruses, such as hepatitis A or E, are spread by the fecal-oral route, when an uninfected person ingests water or food contaminated with the feces of an infected person.
Now that summer is here and travel season is upon us, what are the risks of going to some of the more vaccinated destinations without getting vaccinated?
This is a real risk, and hepatitis A is endemic in countries with poor sanitation, such as parts of Southeast Asia, India, Africa and South America. If you are not vaccinated, you are at risk of being infected. In any case, hepatitis A is not serious enough to become chronic and only in exceptional cases can cause liver failure and serious problems, but when traveling to these areas, hepatitis A vaccination is recommended to avoid contaminated water Infect.
Hepatitis D (or Hepatitis D) is on the rise, what is the frequency?
This is rare. In Spain in the 1980s, the disease affected intravenous drug users and in recent years we have also witnessed an increase in incidence due to migration of people from highly endemic geographic areas. In fact, a prevalence study we conducted in Andalusia found that half of those infected with hepatitis D in the region were immigrants.
It is true that we currently do not know how many patients in Spain are infected with the delta, studies are being carried out in Catalonia and Andalusia, and maybe in a few months we will have data. But we do know that it affects 5% of people with hepatitis C. We don’t have the data because we’re supposed to be delta screening every hepatitis C patient, which hasn’t been done so far, and we hope that with the strategy we’re implementing now in the next few months, we’ll have Everyone who owns a Delta.
What are the characteristics of this emerging hepatitis D?
Hepatitis D is characterized by the fact that it is the most severe form of viral hepatitis, progresses rapidly, and has a high rate of progression to cirrhosis and liver cancer. So, this is a serious hepatitis, and currently we only treat it with interferon, and the effect is not good. Now we have another drug that has been approved by the European Medicines Agency (EMA) and is available in many European countries, but it is awaiting commercialization. The drug’s arrival has revived interest in Spain, who wonder how many are infected and how to treat them. Taken together, this is the most severe and has the highest risk of death.
Perhaps the factor we most often associate with liver damage is alcohol, but what other unhealthy habits can damage this organ?
Currently, the two most common liver diseases in Spain are alcohol-related liver disease and fatty liver disease. The latter is very common and has been linked to being overweight and type 2 diabetes. It’s a potentially serious condition, but it can also be avoided through healthy lifestyle habits such as diet or regular physical activity. A sedentary lifestyle and an unhealthy diet, i.e. high in calories, away from the Mediterranean diet or eating a lot of fast food, are very unhealthy habits for our liver.
Is this liver disease more associated with weekend binge drinking?
No, alcoholic liver disease is related to the amount of alcohol consumed per day: it is related to the amount of alcohol consumed per day and the time of drinking. The toxic effects of alcohol build up over time. Indeed, there is a new pattern of young people’s crazy consumption, and they are also facing risks.
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But it is this habitual, daily, continuous duration that produces lesions in the liver, and these lesions are progressing little by little and silently. Again, the liver is a dangerous organ that doesn’t give warning and we realize when we already need a transplant. The disease can even lead to the death of the patient.
So, we’re told a glass of wine a day is healthy…
Indeed, drinking alcohol must be harmful to damage the liver, and drinking in small amounts is thought not to damage the liver. However, it is important that people know that the only safe amount of alcohol consumption is zero, not drinking.
But, without a doubt, the fact that this disease is one of the most common liver diseases shows that in Spain we have a poor relationship with alcohol.
There is no doubt that in Spain and in developed Europe, one of the most drinking continents, alcohol is closely related to social life. We always drink and eat, we have accepted a relationship with alcohol, if it is harmless: we must limit our drinking, because women more than two units, men more than four units, a unit is a glass of wine or One-third of beer long-term drinking can damage the liver. To protect the liver is to limit alcohol consumption.