Hepatitis C, 400 thousand infected in Italy and half don't know it. Why get screened

Hepatitis C aviral infection which can remain latent for a long time, slowly compromising the liver. In most cases the disease is asymptomatic (or non-specific symptoms such as tiredness and digestive difficulties) for 10-20 years, up to its most advanced stages (cirrhosis and liver failure). The screening tests it is the only tool to find hidden cases, those still undiagnosed, which according to estimates in Italy are around 300 thousand, and consequently limit infections and new infections explains Massimo Andreoni, professor of infectious diseases at the Tor Vergata University of Rome and scientific director of the Italian Society of Infectious and Tropical Diseases. The free national screening program, launched in 2022 thanks to an ad hoc fund, was extended until the end of 2024 with a State-Regions agreement last December.

Free national screening

Screening aimed at born from 1969 to 1989, as well as users of Addiction Services (Serd) and prisoners in prison regardless of their year of birth. The Ministry of Health is also working to include generations born between 1948 and 1968. But in some regions the prevention campaign is still waiting to start (Sardinia, Puglia, Abruzzo and Calabria) or has only started for prisoners and Serd users (Trento, Sicily, Valle D'Aosta).

Since there is no vaccine against hepatitis C, screening is fundamental: If the disease is discovered in time, it is possible to cure it, avoiding the development of serious complications and the need for a transplant, with a reduction in deaths and significant savings for public health – he clarifies Andreoni —. Furthermore, only with screening is it possible to achieve the objective of eliminating the HCV virus set by 2030 by the World Health Organization strategy to which Italy has joined.

How to participate in the screening

The ASL can send the invitation to participate in the test by letter by ordinary mail, text message on mobile phone or electronic health record, based on the regional organization. The invitation generally indicates the structures to contact. Even those who do not receive it can still go to the sampling center of their healthcare company (or to the offices of the voluntary associations participating in the campaign) and request free testing. Reservations are not always required and a doctor's prescription is not required. The screening methods proposed for the search for anti-HCV antibodies (the virus responsible for the disease) are standard blood sampling or fingerstick testing (taking a drop of blood from the finger). The test can also be offered during other laboratory investigations or during a hospital stay.

In case of positivity a further confirmatory test will be carried out to identify the viral RNA. If the person has an active infection they will be referred to the relevant specialist center to begin treatment. good rule – recalls Alessandro Rossi, family doctor president of the Italian Society of General Medicine – always undergo a test for hepatitis C in case of high levels of transaminases, enzymes which if higher than normal can indicate inflammation or damage of the cells of the liver.

Hepatitis C therapy

When chronic HCV infection, if left untreated, causes liver fibrosis which leads to cirrhosis, a condition that can lead to impaired liver function and the risk of developing liver cancer. Collateral complications may also arise, such as renal failure, lymphoma, diabetes, cognitive and cardiovascular disorders. The earlier treatment is started, the less damage there is. Treatment lasts 8-12 weeks. But if the cirrhosis is already very advanced, the only solution is a transplant, Andreoni points out.

How the hepatitis C virus is transmitted

The hepatitis C virus is mainly transmitted parenterally, i.e. through means of contagion with infected blood. These are mostly needles and syringes that are exchangedated for the injection of drugs and other tools reused to dissolve and inhale powdered substances from the nose, the mucous membranes of which can present micro-lesions resulting in even invisible blood residues – clarifies Massimo Andreoni, professor of infectious diseases at the Tor Vergata University of Rome and scientific director of the Italian Society of Infectious and Tropical Diseases -. Once upon a time, the transmission of the virus also occurred through transfusions from infected donors and invasive non-sterile healthcare interventions, a phenomenon which today, thanks to controls, has almost disappeared. Vehicle of contagion they can also be tools for manicure and pedicure and those for tattooing and piercingwhen using non-sterilized equipment.

Symptoms of hepatitis C

More rarely, transmission between cohabiting family members is possible, through the sharing of scissors, razors and toothbrushes, sexual transmission and vertical transmission from mother to child. The categories most exposed to the risk of contagion are drug addicts, those who have other concomitant infections, for example HIV or other types of hepatitis, immunosuppressed people and those living with people with HCV, clarifies Andreoni. Once you have contracted the infection in 30 percent of cases it resolves spontaneouslyand but in the remaining 70 percent the virus remains active and causes slow and progressive damage to the liver – highlights Alessandro Bartoloni, professor of Infectious Diseases at the University of Florence -. The initial symptoms, when present, appear after an incubation period ranging from 2 weeks to 6 months, and consist of tiredness, loss of appetite, nausea, slight increase in body temperature, abdominal pain, jaundice and dark urine. In these cases it is best to contact your family doctor to investigate the possible causes.

In Italy 400 thousand people are infected and half are not aware of it

As of June 30, 2023, reports the Ministry of Health, thanks to the national screening campaign started in 2022 966,498 people were tested for hepatitis C and identified approximately 10 thousand cases of active infection, of which: 1,302 among those born between 1969 and 1989, 7,029 among Serd users and 1,650 among prisoners. The WHO estimates that there are 58 million people affected by chronic hepatitis C worldwide, of which 14 in Europe, and approximately 1.5 new cases of infection per year. In our country the incidence of new cases of symptomatic HCV that are diagnosed is around 0.1 per 100 thousand inhabitants. But c

i would be at least 400 thousand infected subjects according to the most recent estimates: of these, more than half (around 287 thousand) are not aware of having the disease and have no symptoms (the hidden undiagnosed) and approximately 100 thousand people already have liver fibrosis (caused by the Hcv virus) in the very advanced.

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