Avances y desafíos en la eliminación de la Hepatitis C: estrategias innovadoras para combatir una enfermedad global

Resum

Hepatitis C is a chronic viral disease that affects the liver and represents a major global health problem. It is estimated that around 71 million people are infected with hepatitis C virus (HCV) worldwide (WHO) (1). Most infected people have no symptoms for years or decades, making it difficult to detect and initiate early treatment. This infection is characterised by the progressive accumulation of liver fibrosis, and as the disease progresses, if it does not resolve spontaneously or is left untreated, it can lead to serious complications such as liver cirrhosis, liver failure and liver cancer. However, in recent years, significant advances have been made in the treatment and elimination of HCV due to the advent of direct-acting antiviral (DAA) treatments which have demonstrated a high cure rate of close to 95%. These treatments are effective in curing the virus, which can also prevent the complications associated with hepatitis C, and HCV elimination is feasible. Despite the high efficacy of DAAs, an estimated 80% of HCV infection worldwide remains undiagnosed, requiring the implementation and optimisation of active diagnostic programmes to identify those infected with HCV. In 2016, the World Health Organization (WHO), together with other health institutions and governments, established a global health sector strategy on viral hepatitis, with the goal of elimination by 2030. Different member countries of the World Health Organization are working on hepatitis control strategies to achieve hepatitis elimination. So far, only 12 countries are on track to achieve hepatitis elimination targets (2). In the particular case of Spain, it has the National Strategic Plan against hepatitis C (PEAHC), in which different lines of action (epidemiological surveillance, prevention, detection, treatment and research) against hepatitis C have been established. Since the launch of the Strategic Plan for Tackling Hepatitis C, more than 161,000 patients have been treated in Spain with cure rates of around 95%, which shows the effort made to transform the lives of these patients and to position the country as a benchmark in this field. Despite efforts, there are still more than 76,500 people with HCV in the general population, 22,500 of whom have active HCV infection and have not been diagnosed To this end, it is critical to seize every opportunity to diagnose patients by focusing on initiatives to improve prevention, early detection, treatment and comprehensive management. In terms of HCV elimination strategies, a number of measures have been proposed and are being implemented, including improving access to screening, diagnosis, and increasing the availability and accessibility of HCV testing; this involves implementing screening programmes, as well as integrating HCV testing into routine health care services. It is important to identify those infected at an early stage of the disease, as this allows for early treatment and prevents complications associated with disease progression, transmission and transmission to others. Equitable access to antiviral treatment should be ensured for all HCV-infected people, regardless of socioeconomic status or geographic location. HCV elimination strategies also include reducing transmission by implementing prevention strategies, especially in high-risk populations, such as harm reduction programmes, access to opioid substitution therapy, and promotion of safer sex. Finally, it is essential to raise awareness and educate the public and healthcare professionals about HCV, risks, prevention methods and available treatment options. Public awareness can help reduce the stigma associated with the disease and encourage people to seek testing and treatment. Implementation of these HCV elimination strategies aims to reduce the burden of disease, prevent liver complications and improve the health of affected individuals. Collaboration between governments, international health organisations and civil society is essential to achieve HCV elimination as a public health problem.