In 2024, ten years have passed since the approval by the European Medicines Agency of the first direct-acting antiviral (DTA) that managed to cure hepatitis C. A milestone that allowed a 180-degree turn in the history of this infectious disease for the that there is no vaccine. A year later, in 2015, Spain incorporated the drug into public financing with an ambitious Plan to Address Hepatitis C in the National Health System (PEAHC) that has allowed the treatment and cure of more than 165,000 people in recent years. In fact, we are the country in the world that has treated the most patients per million inhabitants, which has allowed us to place the prevalence of the infection at truly low levels, to the point of speaking for the first time of eliminating the disease.
The data from the Seroprevalence Survey of the Ministry of Health (2018) placed the active infection rate at 0.22%, but today it will possibly be around 0.1% of the general population and we would still have to treat and cure about 20,000 people, that is, we have not reached the goal, but there is no doubt that we are very close.
In fact, with the projection of data prior to the COVID19 pandemic, the Polaris Observatory already placed Spain as the only country in the world that could meet in 2021 all the elimination objectives set by the WHO for 2030: reduction by 90 % of new infections; 65% reduction in deaths from cirrhosis and liver cancer; a diagnosis rate greater than 90%; and the treatment of at least 80% of people with the requirements for it.
The collapse of the health system caused by the pandemic slowed down the fulfillment of these objectives, but, once normality has been restored, it should not take too long to achieve what would be a great achievement in Public Health and, why not say it, in the history of Medicine: the elimination of the disease, just over three decades after the discovery of the hepatitis C virus.
The testimony of what this represents can perhaps only be provided by patients who were diagnosed with hepatitis C at the time and could not be treated (and cured) until the appearance of new treatments. As I am already a veteran, I attended many of these cases and it is difficult to describe the anguish of these patients and their families, in addition to the difficulty of controlling the course of a disease that in those years was mostly diagnosed in its most advanced stages. In 2014, before the appearance of direct-acting antivirals, hepatitis C was the leading cause of liver cancer (28.7%) and liver transplantation. In January 2023, it represented 17.5% and has been replaced by alcohol as the leading cause of liver cancer. But above all that, 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 achieving a cure.
To complete this story of collective success of which all public administrations, professionals, researchers, pharmaceutical industry, community entities and, of course, patient organizations have been part, we need just one last effort aimed at two great challenges: for On the one hand, locate the undiagnosed or lost cases that we have the opportunity to identify from the healthcare resources and devices of the health system and among the people who regularly access it; On the other hand, perhaps the most difficult challenge is to actively search for cases among the most vulnerable groups, people far from the usual care circuits and whom we have to reach with decentralized resources and alternative strategies.
For the first major objective, the Alliance for the Elimination of Viral Hepatitis (AEHVE), which integrates scientific and patient societies that work with this objective, has been recommending and promoting age screening in the general population. Today, with what we have learned after COVID, it is very simple and cheap by grouping samples or pooling, as Galicia is doing with excellent results.
For the second objective, the AEHVE is trying to articulate the commitment and collaboration of City Councils and non-profit organizations in the development of actions aimed at vulnerable populations and particularly homeless people, intravenous drug users, and men. who have sex with men and who associate risk behaviors, which are the main sources of active infection. Our program
The history of hepatitis C has already changed, and for the better, in our country. But the time has come to put a happy ending. The fulfillment of the WHO's objectives before the end of 2025, coinciding with the tenth anniversary of the implementation of the plan that has allowed all diagnosed people to be treated and cured, is the “The End” that we are all looking forward to seeing.
Javier García-Samaniego Rey is Coordinator of the Alliance for the Elimination of Viral Hepatitis in Spain (AEHVE)
