Hepatitis C, can we get rid of the virus?

Hepatitis C, can we get rid of the virus?

To advance the elimination of hepatitis C, proposed by the WHO for 2030, and to turn Spain into a territory free of the virus, is the demand placed on the table by the National Federation of Liver Patients and Transplants (FNETH);  the Alliance for the Elimination of Viral Hepatitis in Spain (AEHVE); the Working Group on HIV Treatment ( gTt -VIH) and Positive Support. 

Through the #CribadosinC campaign on the Change.org platform, the aforementioned organizations, together with the Spanish Association for the Study of the Liver (AEEH) and the Catalan Association of Hepatitis Patients (ASSCAT), promote screening actions to detect cases hidden from this ailment.

The initiative, which has the collaboration of the biopharmaceutical company AbbVie, has been launched on the occasion of World Hepatitis Day held this Saturday, July 28.

” We have a unique opportunity to end a public health problem that we can not miss, but we need political will and social support,” explains Eva Pérez Bech, president of the FNETH.

“With the current therapeutic arsenal and the sanitary tools that we have, we can not allow people with the disease to remain without their knowledge, hence our commitment to mobilize this initiative on Change.org,” he adds.

Specifically, according to data provided by the AEHVE , it is estimated that in our coun there are about 50,000 people with this disease do not know they have it .

It is a silent disease that usually does not show symptoms until it is at an advanced stage.

Drug users, main objective

Juanse Hernández, coordinator of the gTt-VIH organization, explained to EFEsalud that drug users are the group that registers the lowest hepatitis C treatment rate.

It really is a population that in all its vital priorities, health is not in the first place, although there are those who do.

Hernandez judges that now is a good time to tell them that this disease can be cured, that there are drugs that are totally effective, that the current treatment is not like the one of yesteryear, which caused “enormous side effects, with many contraindications for this group in concrete”.

But now even having an active consumption can be treated, because trials and studies have shown that these treatments have the same efficacy and the same safety in the general population with hepatitis C as those who inject drugs.

The problem is how to reach these people.

Somehow we should try to take all the diagnosis and treatment of the disease to the attention centers for drug addiction and harm reduction that we know are the places these people go to.

And they would not get lost in the current healthcare circuit that makes it very complex for them.

In his opinion, continues Hernandez, today there is a very favorable environment to get Spain to claim that it is free of hepatitis C and “with a little effort from all parties can be achieved.”

Hepatitis C, anyone can have it

In the case of hepatitis C, up to 40% of affected patients do not know what the transmission risk factor is.

For this reason, they advocate general screening in the entire population, with action plans aimed at more vulnerable populations and improvements in care that facilitate and simplify the patient’s access to diagnosis, treatment and follow-up.

In addition to a call to action to health authorities and social mobilization through Change.org, organizations have launched a social media campaign with the hashtags #CribadosinC and #EliminalaC.

hepatitis C
Infographics of the AEHVE

The problem of reinfection

Reinfection with hepatitis C virus (HCV) after treatment with direct-acting antivirals (DAA) in people with HIV and also infected with HCV was 28 times more frequent in men who maintained sex with other men (MSM) than in people with a history of injecting drug use.

This is at least the conclusion of a study carried out by researchers from GeSIDA (the AIDS Study Group of the SEIMC) and the RIS (AIDS Research Network) in collaboration with the General Subdirectorate of Pharmacy and Health Products of the Community of Madrid.

The results of this research work, coordinated by Drs. Juan Berenguer (Hospital General Universitario Gregorio Marañón) and Juan González (Hospital Universitario La Paz) have been presented at the 22nd International AIDS Conference (AIDS 2018) that is being held these days in Amsterdam

Of the 2,359 patients co-infected with HIV / HCV included in this study, 1,459 reported having acquired infection from injected drug use in the past, 177 were men who claimed to have been infected by sexual intercourse with other men and 723 referred to other risk practices or they had not revealed what these were.

The reinfections were detected an average of 15 weeks after the cure and the vast majority occurred in the time interval between 13 and 26 weeks after the cure.

The review of the medical records revealed that all men who had sex with other men admitted having had multiple sexual intercourse, with anal penetration, without a condom, with different sexual partners and some acknowledged that they practiced  chemsex .

A good investment

For Juanse Hernández, reinfection is a common phenomenon in communicable diseases, especially when there is no preventive vaccine, and it is something to be considered and addressed.

“Here we all have a responsibility and the responsibility is also of the medical teams, of the hepatologists of the infectious doctors who treat the ailment to this group, and that treatment should not only be given to them by the pill but they should accompany it with education about sexual health “

However, he acknowledges that this is “quite difficult because many times doctors do not know what practices homosexual men perform, especially chemsex”.

“They are difficult issues also to address in the consultation and also the care burden they support does not leave them time to address the issue completely.”

“You have to treat these people who have a high risk of infection and transmit hepatitis C, and studies show that you save money to the system in the medium and long term because the chain of infection is avoided.”

Andreu Dalmau

Innovative medicines

On the occasion of this World Day, Farmaindustria has entered the debate to remember that the treatment of hepatitis C is the protagonist of one of the greatest achievements of pharmaceutical R & D of this century.

He also affirms that it is “one of the best proofs that the effort made in the investigation of new therapies translates into advances that are not only capable of improving symptoms or turning into chronic deadly diseases, but also of healing.”

For Farmaindustria the case of hepatitis C is “paradigmatic” because it is a disease that until a few years ago – and until the new direct action antivirals (DAAs) reached the patients – ended up causing complications such as cirrhosis over time , portal hypertension, hepatic decompensation and development of hepatocellular carcinoma, which ultimately resulted in death.

And still today, according to data from the World Health Organization, this pathology affects 71 million people worldwide and is responsible for almost 400,000 deaths a year due to cirrhosis and hepatocellular carcinoma.

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