Hepatitis C, a revolution in place

Prof. Giuseppe Cerasari
Prof. Giuseppe Cerasari

Hepatitis C virus (HCV) is spread all over the world. There are about 71 million people in the world with chronic hepatitis C. Italy is a country with a high presence of the virus in the general population.

This virus is responsible for thousands of deaths per year, due to cirrhosis and liver cancer. Since 1989, the year of the virus discovery, considerable progresses have been made in the treatment of HCV infection, until that date defined with the only exclusion diagnosis: non-A, non-B hepatitis.

Curative therapies, with new second-generation directed antiviral drugs (DAAs), are available since 2015. But the management of such therapies has represented and represents still now a much more complex challenge.

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Which patients to treat? How and when, considering the high costs at least in the initial stages of the treatment? And how to avoid stealing resources to other important healthcare expenditure requirements?

The AIFA (Drug Italian Agency) has managed to obtain the lowest-priced medicines in Europe.Since January 2015, 73,000 patients have been treated in Italy and 95% of cases are fully healed. This unprecedented operation has been made possible by the National Health Service which, unlike what is happening in other countries, has been the only interlocutor for the dealership and its payment.

AIFA has now expanded the eligibility criteria of patient to the cures that, so far, were only available to patients with advanced stage of disease including cirrhotic, transplanted or waiting for transplant patients, patients with hepatic tumors or serious HCV-related illnesses.

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Therefore, it is expected that in the next three years, thanks to a dedicated financial allocation, all patients suffering from HCV infection, from those without liver damage to those with liver impairment, HIV coinfection or severe kidney failure will be treated.

The estimate concerns 300,000 individuals but there is certainly a share of infected people who still does not know to be infected. Patients can now rely, besides to the other treatments already tested in life, on two new combination drugs, all of them free of charge for the patient: one based on elbasvir and grazoprevir, the other one based on sofosbuvir and velpatasvir.

The latter combination is active on all viral genotypes and it also helps to reduce treatment times.From the point of view of public health, this will allow the suppression of virus circulation within the general population.

Hence, in the coming years we will assist to the disappearance of this disease. After the succession of treatments not always free of important side effects and ineffectiveness, today’s hepatologist could finally have high-curative treatments, of short duration and well tolerated.

For this article, we should thank you the kind cooperation of  Prof. Giuseppe Cerasari, Manager of the Center for Study and Management of hepatic and pancreatic transplant, S. Camillo – Forlanini Hospital, Roma.