Published in: Today Digital
Author: Dr. Luis Pérez Méndez, Gastroenterologist-Hepatologist, Clinical Coordinator of the Hepatic Transplant Unit of the General Hospital of the Plaza de la Salud.
On July 28 of each year, the WHO commemorates the World Day against Hepatitis, with the aim of raising awareness and educating the population about viral hepatitis.
There are several types of acute and chronic hepatitis, this time we refer to the chronicles, particularly hepatitis C (HVC) because it is the most prevalent worldwide.
Hepatitis C is a disease caused by the virus of the same name; capable of causing inflammation of the liver, and its clinical manifestations can range from very mild symptoms to severe or complicated forms of the disease.
The hepatitis C virus (HCV) causes acute and chronic infection. In general, acute infection is asymptomatic and rarely (if at all) is associated with a life-threatening disease. Approximately 15-45% of infected people eliminate the virus spontaneously within a period of six months, without the need for treatment. The remaining 60-80% will develop chronic infection, and in these cases the risk of liver cirrhosis at 20 years is 15-30%.
The natural history of the disease is very variable, it is not known what this is due to, but factors related to the host, the virus and the environment are involved. Chronic HVC infection can lead to liver cirrhosis and hepatocellular carcinoma. The incidence of these complications has been significant in the last two decades, however, it is expected to decrease this incidence by 2030. Complications secondary to HVC are the main cause of liver transplantation in the United States and Europe, as well as in the Republic. Dominican Republic where it represents 58% of the transplanted until the year 2017.
Chronic hepatitis C is the only hepatitis that is cured with antiviral treatment.
Successful antiviral treatment prevents complications in the short and long term, however, when they are present they do not disappear, but they are easier to handle and their evolution is slowed down.
Hepatitis C is prevalent throughout the world, it is estimated that there are more than 200 million people infected, in the United States there are more than five million people with the virus.
The most affected regions of the WHO are those of the Eastern Mediterranean and Europe, with a prevalence of 2.3% and 1.5% respectively. The prevalence of HCV infection in other WHO regions ranges between 0.5% and 1.0%. Depending on the country, infection with the hepatitis C virus can be concentrated in some populations (for example, among users of injectable drugs), and / or in the general population.
There are numerous strains (or genotypes) of HCV, the distribution of which varies according to the region. It is more common in men than in women and more frequent in African-Americans than in Caucasians.
The treatment of hepatitis C has evolved significantly in recent years, reaching the era of direct-acting antivirals such as sofosbuvir, daclatasvir, ledipasvir, among others, capable of achieving total healing of the virus, something that years was impossible. These medications are much more effective and safe, and better tolerated than the old treatments; however, access is limited due to the high costs they still have. To choose the treatment, the degree of liver damage (fibrosis or cirrhosis) must be evaluated, by liver biopsy or FibroScan. In addition, a laboratory test should be performed to identify the genotype of the virus. There are six genotypes of HCV, and their response to treatment is different. On the other hand, the same person may be infected by more than one genotype. The degree of liver damage and the genotype of the virus are used to guide therapeutic decisions and clinical behavior.
In the Dominican Republic we have these treatments subsidized by the Ministry of Public Health, with some limitations that prevent total access.