2023-07-28 13:29:17
Hepatitis C can become in Spain in a rare disease. Spain meets all the conditions to become the first country worldwide or to meet all the objectives set by the OMS for the removal of the Hepatitis C: 90% reduction in new infections; 65% reduction in deaths from cirrhosis y Liver cancer; a diagnosis higher than 90% of cases; and the treatment of minus 80% of people with the requirements for it.
«In 2021 without a pandemic involved we would have achieved the objectives. And the data of Polar Observatory This is how it establishes it: in fact we would have been the only country in the world to meet all the criteria set by the OMS. But with the pandemic micro-elimination programs stopped in vulnerable populations, while, in the general population, both the search programs in medical records (people who at some point were diagnosed and had not been treated) and those of screening for risk factors They were also slowed down. Practically no new treatments were applied in 2020 and in 2021 they recovered somewhat but without reaching pre-pandemic levels, until in 2022 we rebounded again”, explains the coordinator of the coordinator of the Alliance for the Elimination of Viral Hepatitis in Spain (AEHVE) and Head of the Hepatology Section of the La Paz Hospital in Madrid, Javier Garcia-Samaniego.
The reasons for this optimism come, on the one hand, from the learning achieved by the diagnostic management of covid-19 and on the other of the learning achieved in the program #HepCityFreethrough which the commitment of local Spanish corporations to the elimination of hepatitis C is promoted, especially in the vulnerable population.
Regarding the first, the coordinator of the AEHVE alludes to the experience that is being developed in Galicia, which is being a pioneer worldwide in el Hepatitis C virus (HCV) diagnostic analysis by sample pooling (PCR)also known as pooling, with excellent health results and considerable economic savings. “This innovation is very important because it greatly reduces the possibility of extending an opportunistic screening strategy by age, such as the one that professionals have been demanding for years,” explains García-Samaniego.
Currently, only a few autonomous communities, such as Cantabria and Andalusia, as well as Galicia, contemplate opportunistic screening by age and also from the Spanish Association for the Study of the Liver (AEEH) about president, Manuel RomeroProfessor of Medicine at the Sevilla University and hepatologist of the Virgen del Rocio Hospital considers that “the cheaper diagnosis that pooling allows could be the way for it to be extended to more communities and the Ministry incorporates it into its recommendations document, which now does not contemplate screening in the general population by age, but rather limits it to factors risky”.
«Spain is very close to eliminating hepatitis C. We still have to treat and cure about 20,000 people. The data from the latest seroprevalence survey of the Ministry (2018) showed a prevalence of active infection of 0.22%. We think that it is even below, close to 0.1% in the general population. So we are very close, and with one more step to diagnose the cases that remain hidden, we will achieve it, “says the president of the AEEH.
Along with the screening approach in the general population, the other challenge is represented by vulnerable populations and particularly the homeless, intravenous drug users, and men who have sex with men, which are the main foci of active infection. Important steps have also been taken in this direction in recent years through the commitment and collaboration of cities with these challenges, tested in the program #HepCityFree, of the EHVE.
A, B, C, D y E
Viral hepatitis -mainly B and C- cause more than 1.5 million new infections worldwide each year, according to estimates by the World Health Organization (WHO). Viral hepatitis (whose main strains are types A, B, C, D and E) can cause inflammation in the liver, becoming a serious health problem. In fact, the WHO estimates that 78% of cases of primary liver cancer and 57% of cases of liver cirrhosis are due to viral hepatitis infections, especially virus B or C.
Hepatitis B, C and D do not produce symptoms until they are in a very advanced stage and their main routes of infection are through parenteral transmission and/or risky sexual practices.
D is the most serious form of viral hepatitis, since its infection can cause serious liver problems (such as decompensation, cirrhosis, or the development of hepatocellular carcinoma). In fact, currently, the only treatment available in Spain against hepatitis D is interferon, an agent that succeeds in suppressing viral activity in only a minority of treated patients and causes many side effects. In 2020, the European Medicines Agency authorized a drug in 2020, not yet financed in Spain, despite the fact that there are between 5,000 and 7,000 people with this disease.
For Romero, who is also coordinator of the local #HepCityFree committee in Seville, “the key role that local communities can play in the fight to eliminate hepatitis C has been demonstrated, especially through the screening of the most vulnerable populationsfield in which Sevilla This program has become a city of international reference, thanks to exemplary mode in which the local administration is collaborating with the autonomous community and with the NGOs that serve these populations”.
Extending opportunistic screening by age throughout Spain, as Galicia has already begun to do, and involving cities in the active search for cases in the population that usually does not access the health system, both the AEHVE and the AEEH consider the disappearance of this public health problem in 2024 or 2025 to be a “more than reasonable” forecast.
Our country is much further away, however, from the elimination targets set by the OMS for hepatitis B, which the Polaris Observatory does not expect to be reached before 2051.
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