The availability of new drugs as of 2012 to treat chronic infection with hepatitis C virus (HCV) has revolutionized the illness, which until now was barely talked about. The hope to heal this illness has been deterred by the high price of medicines during a time when Spain finds itself to be in one of the most delicate economic times in its recent history. However, the restrictions on access to treatment have not left anyone indifferent: doctors who cannot prescribe new therapies to their patients; patients who at all costs want to treat their illness are lured by false promises that announce a cure in the press, radio and television and the pharmaceutical industry, which, with its marketing methods at full throttle, tries to move hepatitis C from receiving very little attention to becoming one of the priorities of public health for the coming years.
There is no doubt that the arrival of the new antiviral against hepatitis C unfolds a very hopeful, new phase in the curing of an illness which, according to estimates, affects 800,000 people in Spain, of which only a quarter know about the diagnosis. However, another different approach is to make patients believe and think that the new triple therapy based on the combination of a protease inhibitor against HCV (telaprevir or boceprevir) together with pegylated interferon and ribavirin will become the best quality of treatment for all patients with hepatitis C. Triple therapy is based on this first generation of protease inhibitors and acts only against the genotype 1 HCV, and their limitations, including toxicity (aggravated by the use of pegylated interferon), decision complexity, and duration and limited effectiveness in certain groups of patients (those who responded worst to previous treatment with pegylated interferon and Ribavirin).
Therefore, the triple therapy with pegylated interferon and ribavirin boceprevir and telaprevir will be the treatment of chronic HCV infection in patients with genotype 1 for a limited time, that is to say, as long as we do not have new and better treatment options. It would be unrealistic to think that, with the still limited therapeutic options and in the current circumstances, we can treat all patients with hepatitis C in Spain. Fortunately, the research and development in the field of hepatitis C is in full swing and very soon will come to find new treatment options.
Many of the organizations that we advocate for put pressure on the health authorities because any patient with hepatitis C should treat the illness as soon as possible and meet the clinical criteria to be able to treat it either through the public health system or through clinical trials (or any other mechanism of early access to drugs).
However, as long as there are no more effective therapies (to heal to a greater number of patients regardless of their viral genotype or its history of previous treatment), more tolerable, easier to manage (without interferon), that can be available to anyone (and in particular the most vulnerable populations, such as injection drug users, people deprived of their liberty and immigrants in difficult administrative situations) and with a more reasonable price that will allow for long-term sustainability, the greatest focus should be on diagnosing the patients who are unaware of their disease so that they can be treated quickly before their liver disease worsens. Hepatitis C is the leading cause of cirrhosis, liver cancer and liver transplants in Spain.
There are many barriers that currently limit the access to treatment for hepatitis C in Spain, one obstacle being the high cost of the drugs, (but not the only) important obstacle today.
As long as the health authorities do not take seriously the approach of the infection by the hepatitis C virus and establish a coordinated policy response to this disease through interventions based on data from a rigorous epidemiological surveillance, which at this time does not exist, and that would allow them to know who, when and how to treat the disease, Spain will continue improvising in the clinical management of this disease.
It is in our hands to change the course of this epidemic. In the same way that society arose in the mid-1980s in a forceful way to fight infection by HIV in Spain, now is the time to do the same with hepatitis C, especially taking into account that we will soon have more tolerable and effective drugs that will eradicate this disease. Nevertheless, this will require the generosity of all the agents involved in the response to hepatitis C, among them, the pharmaceutical industry, to ensure that a greater number of patients will benefit from these treatments.
And to the NGOS and patient associations, we will have to play a vital role: increasing our efforts to raise awareness in society and the political class about the impact of hepatitis C on the individual and collective health and opportunity that is involved at all levels regarding treatment, while putting pressure on the pharmaceutical industry to reduce the price of their drugs.
This should be our goal at this time instead of allowing ourselves to contemplate the false promises that in fact hide the commercial interests of some pharmaceutical companies in the race to position themselves at the top of the market for hepatitis C.
Juanse Hernández
Grupo de Trabajo sobre Tratamientos del VIH (gTt-VIH)
Entidad Declarada de Utilidad Pública
juanse@gtt-vih.org
