2024-10-01 06:53:25
The President of the Alliance for the Eradication of Viral Hepatitis in Spain (AEHVE) and the head of the Hepatology section of the La Paz University Hospital (Madrid), Javier García Samaniego, called for a final effort to ensure that Spain makes history by becoming the countries -the world’s first language in eliminating this Public Health problem, hepatitis C.
Spain is the country in the world that treats and treats the most patients per million inhabitants since 2015, almost 170,000..
Interview with Dr. Javier García Samaniego
We are doing well, but not enough. Can we summarize Spain’s progress in eliminating hepatitis C?
With nearly 170,000 patients treated and cured since 2015, we are the country in the world that treats the most patients per million inhabitants. And this great treatment effort has allowed us to keep the spread of infection at very low levels.
The Ministry of Health estimated it at 0.22% in 2018, and scientists think it would be around 0.1% today. Likewise, we are in line with the goals set by the WHO regarding a 90% reduction in new infections, a 65% reduction in deaths from cirrhosis and liver cancer, diagnosis of more than 90% of cases and 80% treatment. with reference.
However, it would be a mistake to forget that four deaths related to causes related to hepatitis C still occur in a week in our country today and they can be completely avoided, because there is a treatment that looks at the disease in more than 95% of cases.
That’s why you ask for a diagnosis in all adults between 50 and 85 years old …
Yes. The problem with hepatitis C is that it does not cause symptoms for many years and when it appears, in many cases, the liver damage does not change even if we look at the disease.
Therefore, access to treatment, which is something that has been decided in Spain, is not the only key to elimination. What we have to avoid is late diagnosis of infection, which occurs in 1 in 3 cases.
With a prevalence as low as we have, the cases that remain to be diagnosed, treated and cured in all people are, above all, of people who were infected before the 1990s and did not know they had it. There are many studies that support that it is cost-effective. We still have to treat and see some people who are diagnosed with the infection but are not given treatment or are not treated.
And why don’t we?
Well, that’s really what we scientists call ourselves. That is also the recommendation made by the WHO itself in its latest update of the necessary international guidelines to eliminate the disease.
However, this reference is only implemented in our country in isolation in Galicia and some other autonomous regions have been proposed, such as Andalusia or Cantabria, although it has not been implemented.
In any case, the isolated push of some areas is not enough. We need to make this a common national policy, just like public funding of new treatments once and for all.
Which means updating again, in the light of the Galician experience, for example, or the work with AI tools that Andalusia is doing, the Screening Guide of the Ministry of Health, that adds the recommendation to look for infection for everyone in the age , without its connection to risk factors, as it is now.
This is a matter of whether you should go to the Interterritorial Health Committee, because there are no two ways to eliminate hepatitis C.
Have economic factors prevented you?
I believe that today no one disputes that the public financing of treatments is the correct decision not only from a health point of view but also from an economic point of view, because of all the related burden of disease , from cirrhosis to liver cancer or the need for a liver transplant can be avoided if hepatitis C is cured in time.
Note that hepatitis C was the leading cause of liver transplantation and cancer in the past decade. Today this reality has completely changed. In my opinion, the expensive thing would be to stop doing that search which, with the tools we have today, is cheap and easy. And there is one thing that cannot be forgotten and that is that each undiagnosed patient is a source of active infection.
Is hepatitis C testing expensive?
It is not, and also the integration of procedures and diagnostic tools based on AI, which Andalusia is testing, for example, or those used by Galicia to monitor it by age, which are the ones used in OVID (multiple samples) favors a very significant reduction in the sample price.
Today, with what we have learned after COVID, there is no reason to do this screening that scientists recommend, which is also easy to do.
And also that everything will be done?
In the general population, basically yes. With that and the end of this search function are the medical records of the people who are diagnosed and not treated, which are available at the time almost voluntarily by each hospital or in some areas yes and in others no…, we’ll let you do it. .
But we will also have the challenge of promoting elimination in vulnerable groups, which are where most active infections are concentrated.
In this case we are talking about a higher prevalence, which has nothing to do with 0.1% of the population. We can talk about around 8% of the homeless population, for example, or 3.7% of the group of men who have sex with men, in the newly published data. Also, they are a population that requires different skills.
And what is the problem in this case?
The problem is that they are people who do not have access to the health system through normal circles, and we have to reach them with more innovative strategies, normally with the help of NGOs and local communities that work with this population, and with a make a very quick and direct connection between diagnosis and treatment. They are patients who are difficult to reach and easy to lose along the way.
Do you think that cities can do a lot there, despite the fact that there are health responsibilities in autonomous regions?
Yes, that is what we have already shown with HIV, and now it has also been shown with hepatitis C. The city councils are the administration that is closest to the vulnerable people and also the most appropriate to work with NGOs that it serves these collections.
Therefore, from AEHVE we launched the program #HepCityFree, thanks to which there are already 20 Spanish cities that have promotion and awareness programs and specific actions that seek elimination in risk groups.
At the global level, how is the challenge of eliminating hepatitis C progressing?
Sadly, it was slower than expected and impressive. To reach the goals set by the OMS In 2030 we will have to increase the speed.
It must be noted that in the last 10 years, direct-acting antivirals have cured only 25% of the population in need of treatment. That is, we will have until 2030 to take care of the remaining 75% of the population that needs it. Will we achieve it? It’s not impossible, but it seems difficult.
What is the problem?
There are two keys. On the one hand, the key economy. In high-income countries, public finances have contributed to reducing the spread of hepatitis C, but in low- and middle-income countries, the cost has been the deciding factor is whether a person can be cured.
On the other hand, a much more active diagnostic effort is needed, much more reliable epidemiological data and, in general, much greater knowledge and sensitivity.