May 2014.Hepatitis C patients association warns: Public health is denying them access to life-saving medicine 5,000 patients at risk of death.Blockades, protests, public complaints…drug treatment is urgently needed, Sovaldi from Gilead, is designed to address issues in certain affected populations. poison, it’s very expensivefunding from the Ministry of Health is still months away. When it happens, it’s a real revolution. Nearly a decade later, one of the most renowned hepatologists in the field of viral hepatitis research and treatment, Dr. Javier Garcia Samaniego Reyexpressed his satisfaction to EL PERIÓDICO DE ESPAÑA: Spain is the first great country in the world This can eliminate hepatitis C. Their hope is in 2024. “A Milestone” Director of Hepatology Department admitted from the University Hospital of La Paz, Madrid.
According to the latest data (October) ministry of healthfrom 2015 to June 30, 2023, In Spain, 164,502 people have been treated with direct-acting antivirals, 95% of which have been cured. The number of people starting treatment each year has dropped dramatically in recent years. In 2022, 29% of people will have advanced liver disease; In 2016, this number was 62%.
The latest estimates from the Ministry of Health show that in 2018, 76,839 people in Spain were actively infected with the virus among people receiving primary care, of whom 22,478 had not yet been diagnosed. The latest estimates for 2019 put the population prevalence rate in Spain at 0.15%, one of the lowest countries in europe; In the EU, the prevalence of active HCV infection is 0.5%.
Dr. Garcia-Samaniego expressed joy as he answered questions from this newspaper about the scenario. Changes have taken place in just ten years. “This is a milestone for the medical community, in just three years A disease discovered in decadesachieving a treatment that can cure almost all cases, and can talk about its elimination” he pointed out.
The trap of the epidemic
“I hope that by 2024 we can technically discuss elimination,” the expert said.In fact, the latest data from the Polaris Observatory shows that Spain would have actually reached its target at the beginning of 2020 had the pandemic not occurred From the World Health Organization (World Health Organization),” he noted.
“Eliminating the entire disease burden is truly extraordinary. More than 165,000 people have been treated and cured of hepatitis C in Spain,” the expert said.
Eliminate all disease burden “This is truly extraordinary”“, insists the doctor. Likewise, among some vulnerable groups, such as prison personnel, High incidence of hepatitis C, has gone from a prevalence estimate of 20% to actual elimination. The risk of liver disease progression is higher for people who are also HIV-infected, Active infection rate drops from 22% to a figure below 1%.
In fact, the waiting list Liver transplantation in patients with hepatitis C Since 2014, Spain’s infection rate has dropped by 75%.The gradual rollout of antiviral therapy (ADD) to treat infections follows its introduction in 2015 Strategic plan to address hepatitis C (PEAHC), and its clear generalizability to all patients As of 2017with the consensus of the country and the autonomous region, is the decisive factor in this declinethe doctor pointed out.
“For me, as a hepatologist who has devoted almost his entire career to the research and treatment of viral hepatitis, Logically it’s very satisfying The dramatic impact of the introduction of direct-acting antiviral drugs and the spread of treatment, Not just on the liver transplant waiting list, it’s overwhelmingbut in all things related to curing people of infections that can lead to cirrhosis and ultimately liver cancer,” the expert admitted.
Alliance for Viral Hepatitis Elimination (AEHVE)which integrates scientific and patient associations dedicated to the elimination of viral hepatitis and is coordinated by Dr. García-Samaniego and the Spanish Association for the Study of the Liver (AEEH), They appreciate the reduction in waiting lists Liver transplant is “Another great achievement for Spain.”
In 2014, 744 people with hepatitis C were on the liver transplant waiting list; now there are only 184
specific, There were 744 people with hepatitis C in 2014 On the transplant waiting list, Today there are only 184. At the same time, logically, the number of transplants has also decreased over the years, with 135 in 2022 compared to 345 in 2015. 60% reduction. This means that hepatitis C cases account for only 11% of liver transplants today, In 2014, this proportion was 31%, according to AEHVE.
In addition to bringing new opportunities for liver transplantation, advances in eliminating liver disease Diseases require more resources to be devoted to this approach Other liver diseases that have become increasingly popular in recent years are alcoholic liver disease and so-called fatty liver disease (metabolic liver disease).Javier García-Samaniego added that for this reason the ministry has been asked liver health plan. “We must focus on the epidemic What we call fatty liver. It is now the third leading cause of cirrhosis in Spain, after alcohol –Another absolute priority– and viral hepatitis,” he noted.
To be determined
However, despite the positive outlook, AEHVE insists that “not everything is complete”.García-Samaniego admitted: “Yes, maybe In the last 100 meters of the race we hit some roadblocks This makes us go slowerbecause infections are particularly concentrated among vulnerable populations and access is difficult and complex when linking them to treatment“.
Doctors are asking everyone who comes to the health system to be tested and extending testing to the age group with the highest probability of infection (45-70 years old).
Precisely, without age screening of the general population, it will be difficult to diagnose “the fewer and fewer cases that we are seeing.”Scientific consensus has established two paths: Active exploration one of the most vulnerable groups -especially homeless people, injection drug usersand men who have sex with men are major clusters of active infections; and develop Opportunistic age screeningthat is to say, do a test Reaching everyone who comes to the health system, expanding services starting with the oldest age groups Probability of infection in young adults (45-70 years old).
AEHVE and AEHH agree to require this screening, utilizing Reduce diagnosis rate This makes Blood sample pooling Analysis using PCR technology (merged), which has been successfully used for coronavirus and which communities As is already being used in Galicia.
“I only know of its application in Galicia. Maybe once the experience in Galicia is over (it is progressing very quickly) the ministry can re-evaluate it and I know the results of the survey will also give us more accurate information,” The doctor explained.
“Fortunately, serological diagnosis of hepatitis C is not expensive and is much cheaper now. The test includes A simple blood test that costs just over one euro. With the experience gained during the COVID-19 epidemic, Execution strategy Opportunistic screening by age is much simpler, cost-effective, feasible, and easy to implement. ” Hepatology, University Hospital of La Paz.