Spain is very well placed to be the first developed country to eradicate the hepatitis C virus, but the final stretch is always the slowest. The viral disease, which was discovered in the late 1980s, can be cured with antivirals since 2015.
Whoever is diagnosed, is cured. However, there are still a number of patients who are not on the system’s radar because they do not know they have the virus: there are about 20,000, according to data from the Spanish Digestive System Foundation (FEAD). A recent study, published in the journal Lancet Regional Health Europe and referenced by the Ministry of Health, estimates that there are 57,587 people in Spain with active infection (30% undiagnosed).
The infection caused by the virus – which was discovered just 30 years ago – damages the body very slowly. It can take a decade or more to irreversibly damage the liver. So, the antiviral removes the virus but does not cure the organ.
Four deaths related to hepatitis C occur every week, which are preventable, since treatment cures it in almost 100% of cases.
Javier García-Samaniego
— Head of Hepatology at Hospital La Paz (Madrid)
“A decade after the arrival of antivirals that cure the disease, four deaths occur weekly in our country attributable to causes related to hepatitis C that are avoidable, since there is a treatment that cures it in practically 100% of patients.” cases and that, if administered early, it can prevent the damage it causes to the liver over the years,” says Javier García-Samaniego, coordinator of the Alliance for the Elimination of Viral Hepatitis in Spain (AEHVE). and head of the Hepatology section of the La Paz University Hospital (HULP) in Madrid.
Who are they? “People who contracted the infection decades ago and do not know they have it or were not treated at the time,” according to the FEAD. In Spain, many people became infected either through blood transfusions or in the midst of the heroin epidemic of the 1980s and 1990s. Scientific and medical societies propose making “one last effort at information and awareness” with opportunistic age screening for the population over 40 years of age.
In practice, this means informing this population, when they come to their health center for other reasons, that it is advisable to have a blood test that includes the detection of hepatitis C. Always with informed consent. At younger ages, specialists assure that the virus is practically eradicated.
I left the consultation crying; The doctor blamed me, he yelled at me, he told me stupid things. He must have felt so bad that he followed me through the hallways to apologize. I was completely unaware of the virus
Carmen Blas
— 69 years old, 23 with hepatitis C
These are very exceptional cases, warn all the professionals consulted. Carmen Blas is part of that target generation. She spent 23 years with hepatitis C: from when she was diagnosed in 1993 until she was treated with Sovaldi in 2016, after a fight by patients to have universal access to this innovative drug that cures 97% of patients. At that point he already had liver cirrhosis.
When Blas’ infection was confirmed, the virus had recently been discovered. “I left the consultation crying; The doctor blamed me, he yelled at me, he told me stupid things. He must have felt so bad that he followed me through the hallways to apologize. “I was completely unaware of the virus,” he says on the other end of the phone. He is 69 years old and “very eager to live.” She thinks she contracted hepatitis in an intervention she underwent in 1992. Like Carmen, many patients had late access to treatment, when it was no longer possible to repair the breaks that the virus had caused in her body.
Some communities have screening
Now, access is not the problem, but detecting it. Hepatitis C is spread through blood-to-blood contact – like HIV, for example – and does not cause symptoms, like “liver diseases in general.” “The liver is a treacherous organ, hence the effort to raise awareness among the population,” says Marta Casado, president of the FEAD and hepatologist at the Torrecárdenas University Hospital in Almería.
Screening has already been implemented in Galicia and Andalusia wants to launch it soon. “We believe it is an important step for final success,” Casado defends. Cantabria has had some problems: it started it in 2023 but has interrupted it for supposedly violating the patient’s autonomy by not being informed in a convenient way.
The Ministry of Health only contemplates screening for risk groups – such as injecting drug users, those who have sexual relations with risk of bleeding, hemodialysis users before 1975 – and at the moment does not have among its plans to implement a more general one. .
Next year, Gilead’s patent on antiviral drugs – one of the most expensive on the market – expires. This means that the pharmaceutical company no longer has a monopoly.
The Ministry’s argument is that everything that is detected today can be cured, and that many doctors already propose the hepatitis C test – it can be looked at in the same way as HIV is looked at in a routine analysis – to their patients. This debate occurs at a key moment: next year Gilead’s patent on antiviral drugs – one of the most expensive on the market – expires. This means that the pharmaceutical company no longer has a monopoly.
“The journey of the last few decades has been fascinating. It was a liver disease that made patients very ill and now it can be cured, it is one of the greatest advances in medicine in the last ten years,” says the president of the FEAD. During this time, the number of liver transplants due to damage caused by the virus and the waiting list have decreased by 50%, adds García-Samaniego. The last impulse remains, he says: “press the accelerator in the active search.”
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