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European fall week of hepatitis and HIV testing begins on November 20, during which, for the first time, due to the COVID-19 pandemic, people will not be invited for testing. For this reason, the Association of Patients with Liver Disease “Hronos” has organized an online forum to raise awareness of infectious diseases in an emergency, but also to encourage the authorities to make further efforts to eliminate viral hepatitis.
The current COVID-19 pandemic has changed perceptions of viral diseases around the world, but it has also helped to delay or stop health services altogether, such as vaccinations, testing and treatments. Since the discovery of the hepatitis B (1960) and hepatitis C (1989) viruses, significant progress has been made and the lives of many people around the world have improved. A hepatitis B vaccine and a cure for hepatitis C infection have been developed. However, these viruses continue to kill nearly 1.4 million people every year. Of the nearly 360 million people living with viral hepatitis worldwide, only 12% know they have it and only 2% are on treatment. A very small percentage of those infected actually benefit from the findings of Nobel Prize-winning scientists for researching these viruses.
The importance of viral hepatitis tests in the online forum was discussed by the infectologist prof. Milotka Fabri, who said people need to know as soon as possible whether or not they have hepatitis B or C.
– The fact that we think we do not have a virus means nothing, because hepatitis cannot give symptoms for 10-15 years and a person is not even aware that they have it. On the one hand, the disease progresses silently to cirrhosis of the liver, and on the other hand, the patient is a potential source of infection. That is why it is necessary for all people to be tested to find out their status. Commercial tests underway today to detect hepatitis C show cumulative antibodies which can mean immunity, but it is far more common for a patient to still have active disease and for the virus to be present in the blood. Therefore, when a positive test is obtained, it is mandatory to continue the test in the direction of testing the virus in the blood by PCR technique. When you get this positive test, it means that the disease is active. Today, hepatitis C is treatable and the patient must start treatment as soon as possible. As for hepatitis B, it is incurable. The virus can only be kept in check to rest in the liver, but no drugs can clear it from the liver cells. A basic routine test for HBsAg antigens is performed to detect hepatitis B. If there is an infection, these antigens are present in the blood – explains prof. Dr. Fabri.
According to Serbian laws, viral hepatitis is defined as a priority of the health system, but unfortunately in practice this is not the case, especially when it comes to hepatitis C. The exact number of patients with this hepatitis in Serbia is unknown, but based on the frequency of infections in surrounding countries. it is estimated that we have around 70,000 thousand HCV infected.
– Patients with hepatitis B or C in Serbia are treated with modern antiviral therapy. For hepatitis B, the therapy is the same as in all developed countries. This antiviral therapy is fully available to patients and shows good results. As for hepatitis C, the situation is a little more complicated. We have a modern direct acting antiviral therapy that is highly effective and well tolerated, but not available to all patients. In our country, this therapy is administered only to the most endangered and sick patients who have cirrhosis, are preparing for a transplant, are on dialysis or are being treated for haemophilia. But this is not a typical hepatitis C patient in Serbia. She is middle-aged, has mild liver inflammation, and has no cirrhosis. For him, this therapy is not available and we are trying to change it – Prof. told the online forum. Dr Tomislav Preveden, president of the Infectious Diseases Association of Serbia, added that we have to treat about 300 patients per year and that only 120 are receiving new antiviral therapy.
Ivana Dragojevic, president of the Association of Patients with Liver Disease “Hronos”, appealed to the authorities to speed up the issue of the national hepatitis strategy and to loosen the RHIF’s criteria for receiving treatment in order to increase the number of treated patients. According to the current clinical recommendations of EASL (European Association for the Study of the Liver), all patients suffering from chronic hepatitis C and have no contraindications to therapy should be treated with new antiviral drugs.
– Years ago, the Ministry of Health and the RHIF received all the necessary information and arguments that indicate a wrong approach to this problem, as well as suggestions to start a confrontation that would lead us to a solution to this problem, but the situation with the identification and treatment of patients and the education of the general population unchanged today. After receiving the diagnosis, patients manage themselves, buy medicines at their own expense and, at the time of the crisis caused by Covid-19, often pay for the diagnostics themselves, which is very expensive. In order for Serbia to reach the countries of the world and the region in the treatment of HCV, the Association of Patients with Liver Disease “Hronos”, the Association of Hemophiliacs of Serbia and the Association of Kidney Disabled Organizations of the Republic of Serbia, in collaboration with relevant professional associations, initiative “Micro-elimination of HCV in Serbia”. This is a more pragmatic approach to “breaking down” national strategic HCV elimination goals into smaller goals for specific patient populations. This means eliminating hepatitis in specific subpopulations (e.g. inmates, people with haemophilia, chronic kidney failure patients on dialysis, children) – Dragojevic said.
Source: Blic
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