10 years that changed the history of hepatitis C, the elimination of which is already beginning to be observed in Spain
As part of its 49th annual congress, the Spanish Society for the Study of the Liver (AEEH) noted that 2024 will mark ten years since the approval by the European Medicines Agency of the first direct acting antiviral drug (DDA) against hepatitis C. A milestone that, together with government funding new treatments for this disease, agreed upon in Spain a year later, allowed a 180-degree turn in the history of this infectious disease for which there is no vaccine. Since then, more than 165 thousand people have been treated and cured in our country, making it the country in the world that has cured the largest number of patients per million inhabitants, which has allowed the prevalence of infection to be brought to truly low levels.
Data that is highly valued by professionals and patients and which, according to AEEH, allows the elimination of hepatitis C in Spain is now within reach. In fact, our country is already one step away from achieving all the elimination goals set by WHO for 2030: a 90% reduction in new infections; Reducing mortality from cirrhosis and liver cancer by 65%; diagnostic level more than 90%; and treating at least 80% of people with needs. According to the seroprevalence survey conducted by the Ministry of Health (2018), the active infection rate is 0.22%, but today it may be around 0.1% of the total population. An estimated 20,000 people still need to undergo treatment and treatment.
“Together the history of hepatitis C in Spain”
To highlight the enormous collective effort that represents a decade of fighting hepatitis C in Spain, the Congress today premieres the documentary film “Together, the story of hepatitis C in Spain”, produced in collaboration with the biopharmaceutical company Abbvie, which tells the story of the disease from its discovery to the present time, including the emergence of direct acting antivirals and the strategies implemented to achieve the WHO eradication target.
The purpose of the documentary is to spread the success story of eliminating hepatitis C and to facilitate understanding of the current situation by highlighting what remains to be done to end the disease. “We wanted to showcase the work done over the years by everyone involved in the fight against hepatitis C. The combined efforts of health professionals, scientific societies, government administrations and patient associations have been instrumental in implementing strategies that have allowed us to reach the vast majority of people with hepatitis C in Spain,” said Dr. Manuel Romero, President of AEEH.
“Evidence about what this means can probably only be provided by patients who were diagnosed with hepatitis C at the time and who could not be treated (and cured) until new treatments became available. Because I am a veteran, I have treated many of these cases, and it is difficult for me to describe the suffering of these patients and their families, as well as the difficulty of monitoring the course of a disease that in those years was most often diagnosed in its most advanced stages,” he explains. Javier García-Samaniego, coordinator of the Alliance for the Elimination of Viral Hepatitis in Spain (AEHVE), which brings together scientific societies and patient associations committed to the goal of elimination.
“In 2014, before the advent of direct-acting antivirals, hepatitis C was the leading cause of liver cancer (28.7%) and liver transplantation. In January 2023, it was 17.5% and has been replaced by alcohol as the leading cause of liver cancer. But above all, the most important thing is that every person diagnosed with hepatitis C in Spain today has access to treatment and has a 97% chance of cure,” concludes this specialist.
Two great trials
To complete all the work done so far and achieve elimination of the disease, AEEH experts believe it is necessary to move forward in two directions: on the one hand, identifying undiagnosed or lost cases that can be identified using system resources and medical devices. healthcare and among people who regularly access it; On the other hand, actively search for cases among the most vulnerable groups, people who are far from the usual patterns of care and who need to be reached through decentralized resources and alternative strategies.
To achieve the first main goal, the AEEH recommends and promotes the extension of age-based opportunistic screening to all autonomous communities, as well as automatic screening of pregnant women. Currently, only a few communities do this, and only Galicia tests hepatitis C among the age groups with the highest infection rates. It also does this by grouping or pooling samples, a possibility that is worth exploring in other territories and has already been used to combat COVID, with excellent health outcomes and significant economic savings.
The AEEH Congress was the venue for the presentation of some of the results of the strategy led by the General Directorate of Public Health of the Ministry of Health, which turned out to be necessary and effective. Results from age-specific screening from May to December 2023 confirm the prevalence expectation for the general population, which was 0.14%. Similarly, in the 50-59 age group, where prevalence was expected to be higher, screening actually showed a much higher prevalence rate of 0.50%, opening up the possibility of diagnosing and treating new cases. cases in this segment of the population. Consequently, AEEH recommends that this age-based screening be extended to all communities and included in the Department of Health Screening Guidelines, which now limits it to risk factors.
Regarding the second goal, AEEH also considers microelimination interventions targeting vulnerable populations and especially homeless people, people who inject drugs, and men who have sex with men (MSM) to be effective and explains how. For example, the results of the #HepCityFree program, which focuses on these groups and with the support of city councils and non-profit organizations. Thanks to this program promoted by AEHVE, 17 Spanish municipalities with a total population of about 7.5 million people are already actively collaborating in eliminating hepatitis C.
Experts say efforts in both directions “would complete what would represent a great, historic public health achievement: the elimination of an infectious disease for which there is no vaccine, just three decades after the discovery of the virus.” “It causes it.” The reason,” said Manuel Romero, President of the Society.