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Dr. Luis Ml. Pérez Méndez
Gastroenterologist-hepatologist Clinical Coordinator of the Hepatic Transplant Unit of the General Hospital of Plaza de la Salud (HGPS)
On July 28 of each year, the WHO commemorates the World Day Against Hepatitis, with the aim of raising awareness and educating the population about viral hepatitis.
There are several types of acute and chronic hepatitis, this time we refer to chronic, especially hepatitis C (HVC) because it is most prevalent worldwide
L & H Hepatitis C is a disease caused by the virus of the same name; capable of causing inflammation of the liver, and its clinical manifestations can range from very mild symptoms to severe or complicated forms of the disease.
The hepatitis C virus (HCV) causes acute and chronic infection. In general, acute infection is asymptomatic and, in rare cases (or not at all), it is associated with a life-threatening illness. About 15 to 45% of those infected spontaneously clear the virus within six months, without the need for treatment. The remaining 60-80% will develop a chronic infection, and in these cases, the risk of liver cirrhosis at age 20 is 15-30%.
The natural history of the disease is highly variable, it is unclear what is due This, but factors related to the host, the virus and the environment are involved. Chronic HCV infection can lead to liver cirrhosis and hepatocellular carcinoma. The incidence of these complications has been significant over the past two decades, but this incidence is expected to decrease by 2030. CHV-related complications are the leading cause of liver transplantation in the United States and Europe, as well as in the Republic. Dominican where she represents 58% of transplanted until the year 2017.
Chronic hepatitis C is the only one of the hepatitis that is cured with antiviral treatment.
Successful antiviral treatment prevents short-term and long-term complications. However, when they are present they do not go away, but they are easier to handle and their evolution is slowed down.
Hepatitis C is prevalent worldwide, it is estimated that more than 200 million people infected in the United States there are more than five million people with the virus.
The most affected areas of the WHO are those in the Eastern Mediterranean and Europe, with a prevalence of 2.3% and 1.5% respectively. The prevalence of HCV infection in other regions of the WHO ranges from 0.5% to 1.0%. Depending on the country, hepatitis C virus infection may be concentrated in certain populations (eg injecting drug users) and / or in the general population.
There are many strains (or genotypes) of HCV, the distribution of which varies by region. It is more common in men than in women and more common among African Americans than among Caucasians.
Treatment
The treatment of hepatitis C has evolved considerably in recent years, reaching the era of direct acting antivirals. sofosbuvir, daclatasvir, ledipasvir, among others, able to obtain a total cure of the virus, which was impossible a few years ago. These drugs are much more effective and safe, and better tolerated than older treatments; However, access is limited because of the high costs that they still have. To select the treatment, the degree of hepatic injury (fibrosis or cirrhosis) should be assessed by liver biopsy or FibroScan. In addition, a laboratory test should be performed to identify the genotype of the virus. There are six HCV genotypes, and their response to treatment is different. On the other hand, the same person can be infected with more than one genotype. The degree of liver damage and the genotype of the virus are used to guide therapeutic decisions and clinical behavior.
In the Dominican Republic, these treatments are subsidized by the Ministry of Public Health, with certain limitations that prevent full access.
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