Navarra is on track to eliminate hepatitis C virus infection by 2030, thereby meeting the target set by the World Health Organization (WHO). This is one of the main conclusions drawn from the doctoral dissertation “Evaluation of the elimination process of hepatitis C virus in Navarre” by Cristina, graduate of pharmacy and human nutrition and dietitian at the Public University of Navarra (UPNA) to defend. Burj Alcaide. The supervisor of the thesis is Jesús Castilla Catalán, Doctor of Preventive Medicine and researcher at the Biomed Institute of Public and Labor Health in Navarra and Navarra.
As the paper’s authors explain, in order to achieve the above goals, a series of obstacles need to be overcome, such as detection of undiagnosed infection, capture of lost cases, initiation and adherence to treatment and prevention of new hepatitis C virus (HCV) infection. Both Navarra’s health care capacity and existing medicines make this achievable, but to do so, “it is necessary to improve the speed of diagnosis and treatment of active infections,” Cristina Burgi said.
According to preliminary epidemiological studies conducted by the paper, the number of people in Navarre with a history of HCV infection diagnosis increased from 2,014 in 2015 to 2,321 in 2022, but the number of people who maintained an active infection decreased by 84% during that period. same time interval. As the paper’s authors point out, this is due in large part to the commercialization of direct-acting antivirals that began in 2013, resulting in well-tolerated and high success rates of oral drug therapy.
In addition to this epidemiological study, the doctoral dissertation included three observational analyzes of the Navarro Health Services Center participating population, using an anonymous healthcare database. The first analysis assessed the diagnostic activity of active HCV infection based on the results of tests of varying degrees of suspicion in primary and specialist care patients between 2017 and 2019, and made it possible to estimate the diagnostic rate. It also estimated the number of patients with undiagnosed infection. morbidity.
The primary care network made more than half of all new diagnoses, detecting 1 case of active infection per 433 analyzed patients, compared with only 1 new active infection per 1,880 analyzed patients in preoperative testing . The results of these preoperative analyzes allowed us to estimate that between 2017 and 2019 there were between 200 and 300 people with undiagnosed active infections in Navarra, most of whom were born before 1980.
The second approach evaluated an intervention proposed by the Ministry of Health that recruited patients with an incomplete diagnosis of HCV to complete the diagnosis and referred those who were diagnosed for drug treatment. A review of old laboratory results revealed that 281 patients had underdiagnosed HCV infection without good treatment options.
As of the time of this assessment, 67% had been contacted. Of these, 28% had an active infection and were referred for treatment, 40% had false positives, and 31% of infections resolved on their own. “This intervention is a very effective measure, both personally and professionally enriching, because it allows people who do not know they have the virus to be diagnosed with an active infection, preventing them from becoming infected over time. progression to severe stages, such as cirrhosis and hepatocellular carcinoma. Cristina Burgi points out.
“Coordination and close collaboration between different health professions has allowed us to maintain good rates of diagnosis and treatment of HCV infection, which has been affected in part by the COVID-19 pandemic,” he concluded.
The third approach assessed the effectiveness of direct-acting antiviral therapy initiated between 2015 and 2020 at the University Hospital of Navarra and followed until 2021 to examine how many cases achieved a sustained viral response, ie cure. infection. Of the 1,366 patients who started treatment, 19 percent were also infected with human immunodeficiency virus (HIV). This sustained viral response was achieved in 96.6% of patients who initiated treatment and in 97.7% of patients who completed follow-up. After repeating the treatment for patients who failed the first time, the cure rate reached 100%. The drugs showed a good safety profile, as only three of the total number of patients treated had to change treatment due to adverse effects.
The paper concludes that current diagnostic and therapeutic means make it possible to eliminate HCV infection in well-organized healthcare settings, and as Cristina Burgui points out, “achievements depend on the understanding of this Prioritization of goals”.