Thursday, September 23

World Day Against Viral Hepatitis: the treatment that will reduce the complications of this infection to a minimum

World Day Against Viral Hepatitis: the treatment that will reduce the complications of this infection to a minimum

World Day Against Viral Hepatitis: the treatment that will reduce the complications of this infection to a minimum

The hepatitis C is a disease that affects the liver and is caused by the virus of the same name (VHC). This virus is transmitted through infected blood or products derived from it, as well as sexually if there are risky behaviors.

An estimated 70 million people around the world are infected with the hepatitis C virus (HCV). In our country, before the generalization of treatments, 1% of the population, some 475,000 people, had the virus. Now it is estimated that it is 0.3%, about 140,000 people.

It may interest you: Is it possible to eradicate Hepatitis C in Spain?

In Spain, the affected population is mainly made up of blood product recipients or organ transplant patients, prior to 1992.

Injecting drug users also make up a significant portion of those affected by hepatitis C.

In fact, HCV was the most common cause of chronic liver disease and indication of liver transplantation in our country.

This situation, however, is changing thanks to the generalization of direct-acting oral antiviral treatments.

They are high-potency drugs with an excellent safety profile, which are 99% effective, have very few adverse effects, and are easy to take.

A study carried out by researchers from the Hospital Clínic -IDIBAPS and from CIBER of Hepatic and Digestive Diseases (CIBEREHD), published in the Journal of Hepatology, shows that the administration of these treatments changes the natural history of the disease and will cause patients admitted for complications derived from HCV infection will be anecdotal in the coming years.

The first author of the study is Sergio Rodríguez-Tajes, hepatologist at the Clinic and researcher in the viral, toxic and metabolic liver diseases group of IDIBAPS and CIBEREHD, led by Xavier Forns, who is also the head of the Viral Hepatitis Unit of the Clinic and coordinator of the work.

The authors set out to analyze whether there has been a change in the profile of patients hospitalized in hepatology units after the introduction of oral antivirals for the treatment of hepatitis C.

To do this, they reviewed all admissions for cirrhosis and its complications in the hepatology unit of the Hospital Clinic of Barcelona from 2011 to 2019.

A total of 10,053 admissions were evaluated, representing a total of 6,272 patients with cirrhosis. It was found that the number of admissions for complications of cirrhosis due to hepatitis C decreased by more than 50% from 2015, coinciding with the introduction of direct-acting antivirals.

This reduction has also impacted the number of admissions to the ICU associated with cirrhosis due to hepatitis C, which was reduced to less than half.

In Spain, since the implementation in 2015 of the Strategic Plan for the Management of Hepatitis C, more than 130,000 patients have been treated (data up to 2019).

From 2015 to 2016, treatment was restricted to patients with cirrhosis, or with advanced fibrosis, allowing the treatment of a large part of patients with cirrhosis. Later, in 2017, universal treatment was approved.

Drugs prevent the virus from multiplying and infecting new cells. The active ingredients work together and block the different proteins that the virus needs to grow and reproduce, which allows the infection to be permanently eliminated from the body.

They are drugs that are taken orally (pills) once a day, with very few adverse effects and of short duration (8-12 weeks).

There are several combinations and the two most used are: glecaprevir – pibrentasvir and sofosbuvir – velpatasvir.

Regarding the other causes of this pathology, according to the study, alcohol has become the first cause of admission to hepatology units, replacing alcohol. hepatitis C.

Furthermore, the authors report a significant increase in the number of admissions for cirrhosis due to fatty liver (associated with obesity) and autoimmune cirrhosis in recent years.

The results of this study highlight the effort involved in the introduction of direct-acting antivirals for the treatment of hepatitis C and emphasize the importance of implementing policies that achieve the elimination of this disease.

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