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Review
. 2020 Apr;27(3):166-171.
doi: 10.1159/000505582. Epub 2020 Feb 7.

Elimination of Hepatitis C in Portugal: An Urban Legend?

José Velosa  1   2 , Guilherme Macedo  3   4
Affiliations
Review

Elimination of Hepatitis C in Portugal: An Urban Legend?

José Velosa et al. GE Port J Gastroenterol. 2020 Apr.

Abstract
in English, Portuguese

The burden of hepatitis C virus infection remains very high despite huge progress in the cure of the infection. The high prevalence of hepatitis C, especially in vulnerable groups and particularly drug users, may compromise the achievement of the 2030 WHO targets with a 90% reduction in new infections and a 65% reduction in mortality. Therapy with the latest pangenotypic direct-acting antivirals provides cure rates in the order of 97% with short-term oral treatment (8-12 weeks) and with an excellent safety and tolerability profile. Curing the infection causes significant health gains derived from preventing complications from cirrhosis, especially hepatocellular carcinoma, and from liver transplantation. Elimination of hepatitis seems feasible with the implementation of a massive therapy program, focusing particularly on vulnerable populations, through micro-elimination strategies, and in the general population with age-based screening. The reduction of the virus reservoir (humans are the only reservoir) is a determining factor in eradicating the virus.

O peso relativo da infecção pelo vírus da hepatite C permanece muito elevado apesar dos enormes progressos verificados na cura da infecção. A elevada prevalência da hepatite C, sobretudo nos nos grupos vulneráveis e em particular nos utilizadores de drogas, pode comprometer o atingimento das metas da WHO para 2030 com redução de 90% de novas infecções e redução de mortalidade em 65%. A terapêutica com os antivíricos de acção directa mais recentes, pangenotípicos, proporciona taxas de cura da ordem dos 97% com tratamento oral de curta duração (8-12 semanas), e com excelente perfil de segurança e tolerabilidade. A curada infecção ocasiona significativos ganhos em saúde derivados da prevenção das complicações da cirrose, sobretudo do carcinoma hepatocelular, e do transplante hepático. A eliminação da hepatite parece exequível com a aplicação de um programa de massificação da terapêutica, incidindo particularmente nas populaçõs vulneráveis, através de estratégias de microeliminação, e na população geral com rastreio baseado na idade. A redução do reservatório do vírus (o homem é o único reservatório), é determinante para a sua eliminação.

Keywords: Hepatitis C; Micro-elimination strategies; Public health.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
SVR (cure) within 12 weeks of treatment in patients treated with sofosbuvir-velpatasvir (Sof-Vel; Epclusa®) and glecaprevir-pibrentasvir (Gle-Pib; Maviret®). SVR, sustained virologic response; Gt, genotype.
Fig. 2
Fig. 2
Proposed algorithm for the diagnosis and treatment of hepatitis C virus (HCV) infection from a micro-elimination point of view. AST, aspartate aminotransferase; DAA, direct-acting antiviral; APRI, AST Platelet Ratio Index.
See this image and copyright information in PMC

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