Hepatitis C: a ‘silent’ and underdiagnosed disease – 10/05/2020

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Paris, 5 Oct 2020 (AFP) – The hepatitis C virus, whose discovery was rewarded this Monday by the Nobel Prize for Medicine, is responsible for a chronic disease, which progresses in silence before often leading to cirrhosis and cancer of liver, but that we now know how to treat.

Qualified by the Nobel jury as a “major global health problem”, hepatitis C kills 400,000 people each year and 71 million are chronic carriers of the virus, or 1% of the world’s population, estimates the World Health Organization (WHO).

Among them, only one in five (19%) is aware of their disease, due to the very limited access to screening and diagnosis, adds the WHO.

In France, “it is estimated that almost one in three people do not know they are infected,” according to Inserm.

After a phase of acute infection, usually asymptomatic, a minority of patients (15% to 45%) clears the virus spontaneously, but in the vast majority it settles in the liver cells and the disease takes on a chronic form.

However, it remains silent for a long time: it evolves for ten, twenty or thirty years before serious complications arise, such as cirrhosis or liver cancer.

According to the WHO, “among chronic patients, the risk of liver cirrhosis is 15% to 30% over a period of 20 years”.

Hepatitis C is transmitted mainly by blood. Transfusions have been a major mode of contamination, but since the development of a screening test, transmissions by this means have been reduced to practically zero.

Today, the WHO estimates that 23% of new infections and 33% of deaths from the hepatitis C virus (HCV) are attributable to the injection of drugs with non-sterile equipment.

It can also be transmitted during tattoos or piercings with dirty equipment or, more rarely, during sex and from an infected mother to her child.

The treatment of this disease was revolutionized at the turn of the decade of 2010 with the arrival of new “direct action” antiviral treatments, capable of eliminating the virus in a few months in more than 95% of infected people, especially sofosbuvir, marketed by the laboratory Gilead under the name of Sovaldi.

These new treatments make hepatitis C “the only chronic viral disease that can be cured”, highlights Inserm.

Since its appearance, hepatitis C has been steadily decreasing in countries with access to treatment.

In France, 193,000 people had chronic hepatitis C in 2016, compared with 232,000 in 2011.

In other parts of the world, its distribution is, however, hampered by its high cost, even though prices have fallen sharply in recent years with the introduction of generic versions.

At the end of 2017, only 5 million people among 71 million chronic patients had been treated with direct-acting antivirals, a far cry from the WHO goal of treating 80% of infected people by 2030.

“To achieve this goal” and thus eradicate hepatitis C, “international efforts are needed to facilitate screening tests and make antiviral drugs accessible worldwide,” the Nobel committee emphasized on Monday.

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