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The World He alth Organization (WHO) has recognized hepatitis C (hepatitis C) as one of the greatest epidemiological threats. The good news is that the state-of-the-art drugs already available in Poland are effective in fighting the HCV virus that causes this disease. The bad news is that most infections are detected accidentally.
Screening for hepatitis Cis not widely available, and public awareness of the infection is very low: 93 percent of the public do not know what it is HCV . We talk to prof. Waldemar Halota, president of the Polish Group of HCV Experts.
- This disease does not give symptoms for a long time, so it is called the silent killer.
Prof. Waldemar Halota: And there is no exaggeration in that. The identification of HCV before a quarter of a century and the introduction of diagnostic tests into clinical practice made us aware of the scale of the threats. Previously, this disease was considered post-transfusion hepatitis, because it was often preceded by blood transfusion. Later it turned out that the virus is transmitted via bloodstream, but it does not have to be blood treatment. It has also been found that in most people, even chronic infection is asymptomatic. In Poland, minor medical and beauty treatments are the dominant route of transmission of the virus. The margin of the infected consists of sexually infected patients and those whose infection was passed from mother to child. It is estimated that the he alth service is responsible for over 80% of HCV infections in our country.
- How many Poles have had contact with the virus and how many have been infected?
W.H .: We believe that approx. 700,000 Poles may have had contact with the virus. We have approx. 200 thousand people actively infected with HCV, i.e. functioning in a real threat to he alth and life. Everything should be done to abolish the anonymity of this group of patients and to recognize HCV infections in as many people as possible. It is about actively infected because if these patients are left on their own they will develop cirrhosis and hepatocellular carcinoma. And this not only means personal and family dramas, but also a serious social threat and huge budget expenses.
W.H .: Epidemiological studies conducted by the Polish Group of HCV Experts show that men are twice as likely to be infected with HCV than women, and the situation is similar in the case of urban residents compared to rural residents. An important risk group are those treated with blood before 1993, because then there were no tests detecting the virus in the blood. HCV is more often detected among people addicted to narcotic drugs administered intravenously or intranasally. If we are talking about the transmission of infection by minor medical procedures (such as injections, endoscopies, dental procedures, etc.), dialysis patients were still among the high risk of HCV infections a few years ago. Currently, the percentage of infections in this group has decreased from several dozen to about 3%.
Worth knowingYou won't get infected by this route
HCV infection occurs when the blood of a sick person enters the bloodstream of a he althy person. The virus can be found on poorly disinfected surgical instruments and equipment, needles, manicure tools, etc. You won't get infected by:
- sneezing and coughing
- holding hands, hugging, kissing
- use the same toilet, bathtub or shower
- eating food prepared by someone who carries the HCV
- swimming in the same water body, e.g. in a swimming pool, having fun, sports, if it does not happen
- damage to the body and contact with the blood of an infected person.
W.H .: Compared to the previously commonly used interferon therapies, the new drugs are less burdensome for the patient and much more effective. For example, in HCV genotype 1-infected patients, interferon treatment was only successful in 50% of patients. The introduction of new drugs and related interferon-free therapies to clinics has revolutionized our capabilities. Treatment regimens with an efficacy of often reaching 100% and with negligible side effects appeared. It is also important that they are oral medications and are given from 12 to 24 weeks. In the first place, we use these drugs for emergency therapies, i.e. in patients with advanced liver disease who could not be treated with interferon, or the previously used therapy has failed.
Worth knowingHow do the new drugs work?
In interferon-free therapy of hepatitis C, 5 modern drugs with direct antiviral activity are used. They block proteins (NS5A, NS5B) present in the genetic structurethe virus that is necessary for it to multiply. Blocking the proteins also prevents it from infecting new, he althy liver cells. Other ingredients of these drugs slow down the removal of the active substance from the body, thanks to which it has a longer effect on HCV.
W.H .: The information at my disposal shows that so far over 1000 patients have been included in the new therapies. Our experience fully confirms the results of clinical trials. So far, the effectiveness of drugs is 99.5%, and the remaining 0.5% is a patient who was excluded from therapy.
W.H .: It depends on how we count … It is not more expensive if we take into account the effectiveness of the therapy.
W.H .: This is a very pertinent question, because if we included this treatment, which is almost 100% effective, then of course we could eradicate (completely remove the pathogen from the body) HCV. But without money and a systemic screening program, most people who are infected will not be diagnosed. Our calculations show that if we increased the number of patients treated to 15,000. per year, we would have got rid of most HCV infections by 2030. In this context, the sanitary condition of he alth care facilities that could not contaminate becomes a secondary issue, because the HCV reservoir would be trace.
W.H .: With mass screening, the cost of a single test would not exceed PLN 10. The Polish Group of HCV Experts has been taking such initiatives for years.
Worth knowingMany faces of the virus
Viral hepatitis is caused by HCV (Hepatitis C Virus). It was discovered in 1989 and was then called "non A non B". It comes in six varieties, called genotypes. Genotype 1, with subtypes 1a and 1b, is the most common in the world, with 1a predominating in the USA and 1b in Europe. Genotype 2 is found in West Africa but is detected worldwide. Genotype 3 is found only in Southeast Asia. Genotype 4 is dominant in the Middle East, Egypt, and Central Africa. Genotype 5 appears almost exclusively in South Africa, and genotype 6 is widespread throughout Asia. In Poland, infections with genotype 1b dominate - 79.4% of infections, the remaining 3 and 4 HCV.
Not everyone infected will get sick
U 15-20% infected with a virus withouttreatment is eliminated from the body. Unfortunately, 80% do not heal themselves and the infection turns into a chronic form - chronic hepatitis C. As the disease progresses, liver fibrosis develops. Within 20-30 years of infection, 20% of patients develop cirrhosis. The hepatitis C virus is responsible for 25% of liver cancer cases. In the first year of developing liver cancer, the probability of death is 33%. Therefore, the hepatitis C virus has been included in the class I carcinogens.
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