AEHVE asks him to eradicate the infection

The Alliance to Eliminate Viral Hepatitis (AEHVE) is demanding that the Ministry of Health test the entire population aged 49 to 79 for hepatitis C, which has never been done, in order to eradicate this infection, which, despite being cured, still kills four people a week in Spain.

On occasion World Hepatitis DayOn July 28, which is celebrated on July 28, the scientific societies and patient associations that make up AEHVE, committed to the elimination of hepatitis C, declare that, in addition to the test and despite the milestone represented by treatments that allow a cure, progress is being made towards the elimination of this hepatitis and preventing it from being relegated to health policy.

Since 2015, with the advent of direct-acting antiviral drugs, around 170,000 patients have been treated and cured. These figures place Spain among the world leaders in the fight against the hepatitis C virus (HCV).

However, there are still people in Spain who die from causes related to hepatitis C: 188 a year, four a week: “Too many deaths to be satisfied, especially when it is within our power to prevent it,” he points out. Javier García-Samaniego, hepatologist coordinating AEHVEwhich brings together scientific societies and patient associations that work to achieve the disease elimination goals set by the World Health Organization (WHO).

The doctor emphasizes: “This death is avoidable, since there is a treatment that cures the disease in almost 100 percent of cases and, if used early, can prevent the damage it causes to the liver over the years.”

Disability, late diagnosis

The problem is the late diagnosis of this infection, which occurs in a third of cases and leads to the fact that existing damage to the liver in many cases becomes irreversible, despite the cure of the infection.

There are an estimated 20,000 people still living in Spain with hepatitis C who are unaware they have the infection.

Given the prevalence in the general population, which the Ministry of Health estimated at 0.22% in 2018 and which AEHVE estimates to be below 0.1% today, the cases that remain to be diagnosed, treated and cured in the general population are those who contracted the infection two decades ago and do not know whether they had it or were not treated at that time.

For this reason, hepatologists and patients are calling for “the latest efforts in information and awareness” from health authorities to detect undiagnosed infection by offering and performing a diagnostic test (a simple blood test) to the entire population born between 1945 (79 years) and 1975 (49 years) without a prior HCV antibody test.

Not all autonomous communities test for hepatitis C.

AEHVE recalls that WHO itself recommends offering screening testing to all adults without prior testing as a strategy to achieve elimination goals by 2030.

They note that this is an indication that is only performed in Spain in isolation and in some autonomous communities such as Galicia, and would require a new update of the Ministry of Health Guidelines for screening HCV infection, including a recommendation to screen for general infection in the population at this age, without associating it with risk factors, as is currently the case.

“As treatment has shown, the most expensive thing is not to do this screening in the general population, but to stop doing it, because every patient with an active infection is a patient who can transmit the disease to someone who does not have it. And every person diagnosed late (symptoms of hepatitis C are non-specific and can appear before age twenty) will create a large burden of disease – among other things, cirrhosis and liver cancer – for the health system,” explains García-Samaniego.

In addition, the use of artificial intelligence and diagnostic strategies successfully tested during the Covid pandemic can reduce the cost of diagnosis.

“Age-based screening in the general population is entirely acceptable and, in my opinion, should be included in the consensus of the autonomous communities in their hepatitis C policy,” the hepatologist emphasizes.

Another problem: vulnerable groups

In addition to detecting cases of hepatitis C virus in the population with this test, there is another challenge, which is actively searching for cases among the most vulnerable groups, people far from the usual health care pathways and who can only be reached through decentralized resources and alternative strategies.

AEHVE, through its Hepatitis C Free Cities, #HepCityFree programme, seeks to articulate the commitment and collaboration of city councils and NGOs in developing actions aimed at vulnerable populations, especially homeless people, drug users, intravenous drug users, and men who have sex with men and who engage in risky behaviour, who are the main sources of active infection in Spain.

Currently, 20 Spanish cities are already developing or implementing actions on these characteristics and/or awareness-raising and sensitisation programmes.

On the occasion of World Viral Hepatitis Day, these cities are set to launch a campaign through their respective media outlets, external media and social media featuring actor Carmelo Gomez, who was cured of hepatitis C.

His case was similar to other patients who had contracted the virus through blood transfusions before the virus was discovered in the mid-1990s and ended that route of infection, and therefore fits the profile of the typical 50- to 85-year-old patient whom hepatologists insist needs testing.