“I started my career when hepatitis C was a problem and I’m going to end it with solutions”

When Dr. Javier García Samanigo When he began his residency at Madrid’s Princess Hospital, hepatologists worried that a form of hepatitis would contaminate blood banks and eventually lead to cirrhosis and liver cancer. They called it “Not A, Not B,” and the two knew it at the time. In 1989, the year his major ended, a team of researchers discovered the hepatitis C virus and determined its ability to spread through blood. Spain, which is well positioned to eliminate infections, has an estimated 25,000 to 50,000 undiagnosed people with cured diseases.

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“I started my career when hepatitis C was a problem, and I would actually end it with a solution,” said the doctor, who heads the liver department at La Paz University Hospital, in his brightly lit office. person in charge. With dozens of jobs behind him and a strong commitment to ending the infection, he admits he put in “a little sand, not throwing in a lot of donations, but getting as many people as possible and lobbying with the coalition to get achieve this goal”. Elimination of viral hepatitis in Spain”, he is the coordinator of the event.

How long will it take Spain to eliminate hepatitis C?

We are very close. The total number of sick people in Spain is between 200,000 and 230,000. Since the discovery of this virus, we have had some very good drugs that can cure this infection with a cure rate close to 99%. As a fortunate result of the Hepatitis C Strategic Plan approved in 2015, we have treated approximately 165,000 patients. It’s broad, not as broad as an election survey, but there may still be 25,000 to 50,000 people to diagnose and treat.

Where does this country stand relative to other countries in our environment?

Spain is doing very well, topping the international elimination indicators. The World Health Organization has set a goal of eliminating hepatitis B and C globally by 2030. To do this, morbidity, new cases, must be reduced by 90%, and chronic liver disease morbidity and mortality by 65%. We’ve actually achieved that, and we’ve treated more cases per million inhabitants than any other country. A mathematical model that predicts when hepatitis C will be eliminated shows Spain in the lead. The most famous say it will be the second country after Iceland, but IMHO that’s demographically irrelevant. Eliminating hepatitis C in a country of 300,000 inhabitants (the health area equivalent to a relatively small hospital in Spain) is not the same as eliminating hepatitis C in a country of 47 million inhabitants. To give you an idea: La Paz hospitals care for 600,000 people.

The most famous mathematical model says Spain will become the second country after Iceland to eliminate hepatitis C, with a population similar to the health area population of any Spanish hospital.

How do you find a virus that few people get infected with and most cases lie dormant for years without showing symptoms?

The hepatitis C program is doing extremely well in accessing treatment, reaching 160,000 patients since 2015. Efforts still to be made are to actively seek out those who do not know they have hepatitis C, which can occur in up to 20% of Hispanics. These patients are certainly the hardest to find because infections affect vulnerable populations farther from the health system: drug users, the homeless, or people coming to work from other countries with higher prevalence. In addition, the epidemic has delayed all demolition plans.

Since direct-acting antivirals became available in Spain in 2014, deaths have fallen by almost 50%, to 435 by 2021. Has any infection experienced such improvement in such a short period of time?

not any. This is macro, even micro. You pass the gastronomy room of the hospital (La Paz), or the gastronomy room of 12 October, or to Ramón y Cajal, they no longer accept patients due to decompensation of liver disease. For example, viruses produced by alcoholic liver disease came in, and those slightly rarer ones came in, but those produced by viruses (including B) were gone.

These treatments can cure the infection, but will they reverse the liver damage done so far?

If you are infected with C virus and take antiviral medicine, the infection will be cured. Another thing is that the damage that the virus has done is completely irreversible. The liver is an organ with excellent regenerative capacity, but patients with cirrhosis face the risk of malignant transformation of liver cancer. If we cure their infection, we compensate them, the disease improves and the risk decreases, but it doesn’t go away, so they should be included in a systematic screening program.

It has been 10 years since the patient demonstrated in front of the Ministry of Health (Sovaldi), but it seems that it has been 100 years.They are under a lot of stress, more so than the hepatologists who are also demanding these treatments

What have you done Delayed inclusion of Sovaldi in essential services portfolio?

I prefer to say positive things. In the long run, the fact that tens of thousands of people were able to get treatment was a revolution. A week is a long time for a patient, but I wouldn’t say that there is a long delay compared to neighboring countries. The stress of the patient is greater than that of the hepatologist, who also demands these treatments. This is a dramatic moment. Less than 10 years have passed since patients demonstrated at the Ministry of Health, and it seems like 100 years have passed. They are ready to spend 1.5 billion euros for hepatitis C patients, they say yes, a lot, but they are cured.

If I had to rate the performance of public administration, central government and the community in terms of treatment methods, I would say it is very high, if not outstanding. The evidence is that no country in Europe is as successful in treatment, or treats as many people per million inhabitants, as Spain.

Were some of the patients who received blood transfusions before 1990 untested?

Some people may be missed, but 99.9% of people can be diagnosed, treated and cured. Another issue is the rise of intravenous drug addiction in Spain in the late 1980s and 1990s. They’re people of my generation, today’s 20-somethings who don’t live in that environment. Prosperity HIV and hepatitis. The Ministry of Health’s seroprevalence survey tells us that there is no hepatitis C among people under the age of 30 who go to primary care institutions; few people go out between the ages of 30 and 40; and there are already significant numbers after the age of 40. Many of these people may be in community centers, drug addict care centers, shelters, pot kitchens…these are places where action must be taken.

Will hepatitis C be the first infection to be eradicated without a vaccine?

I prefer the word “eliminate”. Only one virus has been eradicated from the face of the earth, and that is smallpox. In order to eradicate this disease, you need zero incidence on the entire planet, and for that there must be a vaccine. For hepatitis C, our medicines may work better than the vaccine in terms of treatment, but they’re not reaching every country. In fact, a certain proportion of patients who are not immune to hepatitis B after vaccination, about 3%, may be higher than the risk of hepatitis C treatment failure.

Why hasn’t this vaccine been found yet?

The virus has traditionally been elusive because of its high rate of mutation within individuals. Although some models have come close to achieving antibody-generating vaccines, they have failed in terms of reproducibility. If you add that to the fact that there are good treatments for hepatitis C, perhaps this will raise the alarm in some research groups.

Pooling was used to screen low-risk populations, including PCR on a hundred samples.If it’s positive, you can do other lesser ones, but most of them are negative, so they save time, energy and resources

Galicia has implemented a groundbreaking system derived from COVID-19, collection. What is it made of?

Opportunistic screening is being done in some communities to encourage people who have come to the health system, family doctor but have not yet been tested to get tested, mainly in certain age groups. 75-80% of cases of this disease occur in people over the age of 45.he collection It is used to screen low-risk groups. “Pool” means pool in English, and the technique involves performing PCR on a hundred samples.If it is positive, you can do collection Lower, but most tests come back negative, so they gain time, energy and resources.

What role do cities play in eliminating hepatitis C?

In the league, we have a program that we’ve been ramping up. Cities have no sanitation capacity, but they take care of the vulnerable in shelters, soup kitchens, etc. Screening with rapid diagnostic tests, like screening for COVID-19, you can look for patients in these groups and if you diagnose a case, refer them to the health system. Seville did an excellent job of finding between 50 and 80 patients in a screening program targeting the general population and vulnerable groups. We also have an ambitious plan in place for all drug addict care centers in Madrid.

Once viral hepatitis is eradicated, where will efforts go?

Hepatology is increasingly focusing on cases of metabolic liver disease, as viral cases are entirely anecdotal. Metabolic disorders, diabetes mellitus, dyslipidemia, hypercholesterolemia, and obesity have emerged with increasing obesity epidemics and increasing life expectancy in many Western countries. This results in a diffuse deposition of fat in the liver, triggering a cascade of mechanisms that can lead to inflammation and progressive liver disease.

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