Hepatitis C, Close to a Happy Ending

Doctor Luis Morano AmadoHead of the Department of Infectious Diseases Meixoeiro Hospital in Vigoexplains the main problems and achievements in the fight against hepatitis C, as well as the situation in Galicia:

What are the incidence rates of hepatitis C in Galicia?

The most recent data on the prevalence of hepatitis C virus infection in Spain come from a seroprevalence study carried out by the Ministry of Health in 2017-2018. Extrapolating their data to Galicia led to the estimate that around 4,500 people may be suffering from an active, untreated infection with the virus, 30% of whom will not know it (1,300 people). Most of these infections (3,800 infected) are concentrated in the 40-69 age range. Each year, the number of patients diagnosed and treated in the Vigo region is approaching 150 patients.

How do you assess the Hepatitis C Elimination Plan in Galicia?

The plan, developed by the Directorate General of Public Health of the Ministry of Health, is the most ambitious in Spain and is the envy of health workers in the other autonomous communities. It complements and improves the Ministry of Health’s screening guidelines and, as a novelty, introduces opportunistic age screening in the age groups (40-69 years) that account for 85% of active HCV infections. Health workers have to thank the Directorate General of Public Health and the previous Minister of Health (Julio García Comesaña) for this initiative to write and implement this plan, as well as the current Minister for continuing the planned development of the same.

What is the “opportunistic test” carried out in Galicia?

85% of active hepatitis C virus infections are concentrated among the population aged 40 to 69 years. One of the areas of the Elimination Plan in Galicia is age screening of people aged 50 to 59 years. Active recruitment of people of this age visiting any medical center of the Galician health care network is carried out with the stated goal of screening at least 45% of these people.

How to access screening?

When one of these patients gives a blood test for any reason, a request is automatically generated to determine the presence of hepatitis C virus particles in their blood (PCR), the responsible doctor informs the patient about this, and if the patient gives verbal consent, the patient’s sample is grouped into batches of 100 samples (pooling method), in which it is detected if there is a positive sample. The obligation is that infected patients are counseled within a maximum of 3 weeks. Between January and December 2023, 53 percent of the target population was screened (the goal was to cover at least 45%).

What symptoms are possible warning signs?

There are no clinical warning signs that can help in the early diagnosis of hepatitis C virus infection. In recent infections, the infection is usually asymptomatic (60–75% of cases). Symptoms, when present, include asthenia (fatigue), weakness, nausea, decreased appetite, and joint or muscle pain. A small percentage of symptomatic cases have elevated bilirubin levels with yellowish pigmentation of the skin and conjunctiva (jaundice), as well as dark urine and loss of stool pigmentation. Between 15% and 20% of these infected individuals will spontaneously clear the virus without pharmacological treatment due to the effectiveness of their immune system; the remainder (80–85%) will suffer from chronic infection.

What are the symptoms of chronic infection?

Symptoms are mild or the patient simply has no symptoms until the disease is advanced due to infection, so the diagnosis is usually made by chance. Up to 20% of patients may develop a terminal liver disease called cirrhosis, and 1 to 5% of these patients will eventually die from complications related to cirrhosis or from the development of liver cancer (hepatocarcinoma).

How are diagnoses made outside of screening?

Knowing the risk factors for contracting this infection allows the patient to ask his doctor to perform diagnostic tests to rule out this infection. Currently, rapid tests can be performed on saliva or blood samples obtained by pricking a finger, available in various medical devices: departments for the study of addictive behavior, various NGOs, mobile devices…

What other variables affect test performance?

Doctors should perform tests on people with risk factors for infection, patients with elevated transaminase levels or those suffering from pathologies or social situations often associated with hepatitis C virus infection (alcoholism, mental illness, addictions, vulnerable people, sex workers…).

Is Hepatitis C Already a Rare Disease?

The answer is a resounding NO. This is our goal, which could possibly be achieved in the coming years in Spain. The targets to be achieved by 2030, proposed by WHO to achieve the elimination (not eradication) of the hepatitis C virus, include a 90% reduction in new infections and a 65% reduction in mortality associated with this infection. The Hepatitis C Elimination Plan states that to eliminate hepatitis C as a public health problem in Galicia, the incidence (number of new cases) must be less than or equal to 5/100,000 inhabitants and the mortality must be less than or equal to 2 deaths per 100,000 inhabitants. achieved 100,000 inhabitants. These targets are far from being achieved in most developed countries. Iceland and Spain are countries that could achieve this in the coming years.

What is the situation in the world?

The WHO estimates that the prevalence of hepatitis C in the general population worldwide is 0.8% (almost 60 million people), with an incidence (new infections) of 1.5 million annually, and a mortality rate of 300,000 deaths from this infection (liver cirrhosis, hepatocellular carcinoma) in 2019. A significant percentage of these people are unaware of their infection, in addition to the fact that access to antiviral drugs is uneven across countries: it is estimated that only 60% of infected people receive treatment worldwide.

Leo Caldas the movie who didn’t know he was sick

Actor Carmelo Gomezwho played the role of policeman Leo Caldas in the writer Vigo Domingo Villar’s film adaptation of “The Beach of the Drowned,” stars in the #HepCityFree campaign Alliance to Eliminate Viral Hepatitis in Spain (AEHVE). His case was similar to that of other patients who contracted the virus through blood transfusions before that route of infection was discovered and eliminated in the mid-1990s. Like other patients who may now have the infection and not know it, the actor did not know he had the disease until he became infected. He found out by accidentwhen he went to donate blood in the late 90s and was told he couldn’t because he had liver disease. After that, he suffered from exhaustion and agony due to the progression of the disease. Years later, direct-acting antiviral drugs were developed, and he was able to cure himself in a few weeks with pills. The #HepCityFree program in 20 Spanish cities, including Vigo, offers to find people living with hepatitis C and not knowing it.

As AEHVE points out, the “luck” of patients diagnosed today is that they know that their disease is treatable and that this treatment is effective in almost 100% of cases. Hence the importance of early detection of the infection, before it causes liver damage that can become irreversible. “Fortunately, with Carmelo we arrived in time, and with the diagnostic and treatment options we now have, we should arrive in time for the hundreds of patients who still die every year in Spain from causes related to hepatitis C,” says the hepatologist. Javier Garcia-SamaniegoCoordinator of AEHVE, which brings together scientific societies and patient associations committed to eliminating hepatitis C, and promotes the #HepCityFree program, which encourages cities to participate in finding the last cases of hepatitis C.

A search that hepatologists believe should be conducted both among the general population and by Hepatitis C test for all adults aged 50 to 85 years without a previous negative testfor example, particularly in vulnerable groups where prevalence is higher and more difficult to access.