INTERVIEW. While the eradication of hepatitis C is within reach, hepatologists are calling for the establishment of systematic screening in adulthood.
Hepatitis C may soon become a disease of the past. Thanks to therapeutic advances, patients can now be completely cured.
Universal access to the latest innovations has enabled this paradigm shift. Due to their exorbitant cost, these molecules were initially limited to patients awaiting a liver transplant. The tough negotiations between the government and the laboratories then made it possible to gradually open up access to patients suffering from cirrhosis. And since the start of 2017, hepatologists can prescribe these revolutionary treatments to all patients infected with the hepatitis C virus.
Since 2016, more than 30,000 people have benefited from these molecules. There are still 150,000 patients to be treated. The eradication of this chronic pathology therefore seems within reach. But one obstacle remains: some 75,000 people are unaware of their infection. The establishment of universal screening is essential if we want to succeed, believes Professor Christophe Bureau, secretary general of the French Association for the Study of the Liver (AFEF) and hepathologist at the Toulouse University Hospital.
What made it possible to implement universal treatment for hepatitis C?
Prof. Christophe Bureau: For a very long time, drugs were ineffective with less than 50% effectiveness. But above all, they were very poorly tolerated and caused significant side effects, which limited the possibilities of prescription. We only prescribed them to patients with severe forms.
But today, the treatments reach effectiveness rates higher than 95%. Failures and serious side effects are exceptional. And then the treatment times are short, generally between 8 and 12 weeks. This allows us to offer the treatment to patients who do not have severe liver damage. And in treating these patients, we have found that extra-hepatic complications, such as fatigue, are improving.
And after treatment, do patients still need to be followed?
Prof. Christophe Bureau: It depends on the patient’s assessment before treatment. Some are only carriers of the virus and have not developed liver disease. If they do not present other risk factors for hepatic complications (alcohol, hepatitis B, NASH), they may no longer be monitored.
On the other hand, patients with severe fibrosis, and in whom the virus is eliminated thanks to treatment, are always at risk of cirrhosis or liver cancer. In addition, these patients are generally confronted with comorbidities. It is therefore important to continue monitoring.
Listen to the full interview with Prof. Christophe Bureau
Eradication is near. But it is still necessary to have access to all the sick …
Prof. Christophe Bureau: Indeed, it is assumed that between 70,000 and 80,000 patients are unaware of their HIV status. However, if we want to ensure the eradication of the disease, we absolutely have to go and find these patients. These are, on the one hand, patients who are difficult to access, such as very precarious people who live on the streets or migrants. And on the other hand, there are people who cannot imagine being infected because for many years it has been said that the risk factors for hepatitis C transmission are blood transfusion and drug addiction. However, patients with these risk factors have already been screened.
Today, there are still patients who do not present obvious risk factors. These people could have been infected in the 1980s during invasive treatments such as the treatment of varicose veins, colonoscopies or even dental treatments which were not carried out with all the hygienic precautions that we know today. Piercings and tattoos also pose a risk of transmission of the hepatitis C virus.
We have all been able to be infected during a benign act. So even in the absence of obvious risk factors, you still have to get tested at least once in your life as an adult.
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