One of the biggest obstacles is no longer the cost of treatment, but the screening of people who have been infected by the virus without their knowledge.
Since the introduction in 2014 of direct-acting antiretrovirals (DAAs) that cure hepatitis C, hepatologists are optimistic in view of the fact that many countries are now considering eliminating the disease in the medium term.
Currently, all patients infected with the hepatitis C virus can be cured within three months by taking a single tablet daily, regardless of the progression of the disease. This contrasts with that of twenty years ago, when without effective treatment at that time the number of deaths from the disease was estimated at more than 3,600 per year. "Thirty years after the discovery of the virus, hepatitis C has become the first chronic disease that can be cured in almost 100% of cases," said Pr Patrick Marcellin, president of the last Paris Hepatitis Conference, who gathered 1000 experts from all over the world in January in Paris.
A first important sign of the effects of DAAs is that hepatitis C is no longer a major cause of liver transplantation in Europe, according to a study conducted from European registers of liver transplants. Their number has fallen by half since 2014 and more than 600 livers are now released every year for other indications such as alcoholic cirrhosis or primary liver cancer.
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In the United States, hepatitis C is no longer the main cause of liver transplantation since 2016, displaced by alcoholic cirrhosis and now NASH, a liver-related inflammation of the liver that can cause cirrhosis of the liver. In addition, the ability to treat transplant patients with a virus-infected organ further expands the stock of livers and other available organs.
The goal of French hepatologists is now to eliminate all cases of hepatitis C by 2025. 100% reimbursement of treatment since 2016 for each infected patient and improved screening of target populations such as drug users, prisoners and people infected with HIV must contribute to this.
"After the treatment of the most serious cases, we recalled patients who could not be cured by previous treatments or who refused because of their side effects," says Patrick Marcellin. This recall is also under way in the United Kingdom, a country that rationed its treatment because of its costs but finally released a billion pounds last year to treat the estimated 160,000 patients by 2025.
Several countries around the world are already well positioned to meet the World Health Organization's goal of reducing mortality by 20% by 2030 and by 80% against infections by 2015. In addition to France and the United Kingdom, the Polaris Observatory obtains Australia, Georgia, Switzerland, Italy, Spain, the Netherlands, Egypt, Iceland, Japan and Mongolia.
One of the main obstacles is no longer the cost of treatment, which comes with the arrival of new DAAs and generic medicines in developing countries, but the detection of people who have been infected by the virus without their knowledge. The task is immense because only 4 million patients have been treated by DAAs on more than 70 million chronic carriers of the virus in the world.
Towards universal screening
"In France, a little more than 100,000 people have to be treated, including about 75,000 people who do not know their status and who are most difficult to raise awareness because without known risk factors," says the president of SOS Hepatitis, the doctor Pascal Melin. In addition, the number of treated and curative patients decreased for the first time in three years. It has risen from 18,000 in 2017 to 14,000 in 2018, a sign that the most visible cases are now supported.
To find infected patients who do not know each other, can universal screening be effective? Should the openness of the Ministry of Health for prescribing treatments by GPs help them convince more people to seek treatment? These measures cost, is it still necessary when the treatment remains effective in the stage of cirrhosis and that it is unlikely that the infected persons will infect others? "In any case, it is very important to make the general public aware of the chronic health problems caused by the infection", Pascal Mélin concludes, because everyone who has been diagnosed can now benefit from this therapeutic revolution.