2023-06-29 10:36:00
Thanks “to the 250,000 treatments already carried out in Italy at the moment we are repaying not only the therapies but also future screenings. We have recorded a reduction in cirrhosis, cases of hepatocellular carcinoma, liver transplants and deaths. This in terms of cost-effectiveness is highly valid, so we need to move in that direction. We have asked the Ministry of Health for an extension for screening until 2025 and to broaden the age range of the population, i.e. to also screen people born between 1948 and 1968. All this, if it goes through, will further facilitate the achievement of the goal that WHO asks of us, namely the elimination of the hepatitis C virus by 2030″. This was stated by Massimo Andreoni, scientific director of the Italian Society of Infectious and Tropical Diseases (Simit) on the sidelines of the international conference ‘New horizons in HCV – completing the elimination process’ which saw experts discuss the state of the art in Milan of treatments and unmet needs in the management of HCV in specific populations to provide some useful insights for the identification and treatment of patients with hepatitis C in daily clinical practice.
Being an asymptomatic infection, it is “more difficult to ‘find’ the undeclared, i.e. all those patients who have contracted the HCV virus but ignore it – adds Ivan Gentile full professor of Infectious Diseases Federico II University of Naples – Positivity comes discovered by chance, such as after the person has had tests to prepare for surgery”. However, what makes the difference is the availability of “exceptionally active and well tolerated drugs – he continues – With a course of treatments of 8-12 weeks we manage to eradicate the infection in practically 98% of patients however. The real problem then is to find the positive cases. To do this, we need to focus on groups at risk, drug addicts and the over 65s”.
If the HCV is not eliminated, “there may be a progression of liver damage towards cirrhosis – explains Vincenza Calvaruso, Italian Association for the Study of the Liver (Aisf) – with a clinical picture that cannot go back, to a functioning liver , but which goes towards the disease, the hepatocarcinoma. Then there are other extrahepatic pathologies related to HCV infection: lymphomas, some cognitive deficits and neurological and cardiovascular diseases. The treated patient – Calvaruso reiterates – can interrupt the progression of the disease. An antiviral treatment carried out in a phase of mild disease ensures that the patient does not undergo cirrhosis, therefore it allows the maximum clinical benefit because, in fact, the liver remains normal even over the years. When, on the other hand, we intervene at a more advanced stage – notes the expert – we obtain a benefit, but a smaller one” because “we reduce the risk of complications. The patient with cirrhosis, however, must be treated in any case because – she recalls – the treatment reduces the risk of decompensation and hepatocellular carcinoma. There are data that show “a minimum of benefit” even in these patients. This is the moment when there are no more patients who should not be treated “.
The elimination of HCV is a process that “includes several important steps – underlines Alessio Aghemo, professor of Gastroenterology at Humanitas University of Milan – first of all the identification of 80-90% of people with hepatitis C and the treatment of 80% of the cases identified”. Thanks to these steps “99% of patients are able to recover, as a result new cases decrease” as the transmission of the virus decreases “deaths decrease because once healed patients no longer generate complications, they no longer die of liver disease. On paper it is very simple, in reality achieving these objectives is very complex. Some Regions, “such as Lombardy – explains Aghemo – have screened many people in hospitals (hospitalized or who access the blood collection center). It is a simple strategy but, if we focus on an age group, i.e. the population born between 1969 and 1989, as foreseen by the current ministerial decree, we know very well that there are few people of this age who access the hospital. Therefore, the risk is that of not being able to reach these people. Other Regions, such as Basilicata – he continues – have involved general practitioners, but not all have joined the initiative, and therefore this too is a very difficult plan to apply. The right strategy, however, requires several steps: a campaign to raise public awareness, associate the hepatitis C test with other diseases so that the person undergoes several tests at once – he concludes – and involve the medicine of the territory”.
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