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Hepatitis C: New guideline should help eliminating the disease, says Dr. Raymundo Paraná

Previous guideline limited treatment to patients with moderate or advanced fibrosis while the current guideline allows universal treatment


Brazil has a challenge do widen patient access to diagnostic, since the diseases rates, although increasing, are still lower than expected

Recently published in the Official Gazette (Diário Oficial da União – DOU), the updates of the Clinical and Treatment Guidelines for Viral Hepatitis, which to Dr. Raymundo Paraná, represents greater access, easier treatment and cure rates above 90%. According to him, a paradigm shift will also imply in Brazils possibility to eliminate hepatitis C in the future, at least as a public health problem.

This therapy guideline includes new schemes and widens patient access to diagnostic and treatment. The previous guideline limited treatment to patients with moderate or advanced fibrosis, while the new one allows universal treatment. This aspect directly affects our Reference Centers, crowded with hepatitis C patients, who now, treated and cured, will be discharged, allowing a greater turnover and widening access for patients with chronic liver diseases or other diseases related to public ambulatories, he explains.

To the specialist, simplifying therapy schemes and the ease to manage patients for the low drug side effects are factors that should allow a quick implementation of the guidelines. Still according to Dr. Paraná, we must increase the number of Reference Centers and reinforce the responsibility for the treatment to Basic Assistance physicians. In his opinion, patients with mild liver disease by hepatitis C can be treated by general practitioners or other specialties.

As another way to ensure broad access to hepatitis treatment, the government expects to treat 657 thousand people with hepatitis C in the next years, with 50 thousand people still in 2018. To Dr. Paraná, this is possible because Brazil already treats a very large number of people, reaching 30 thousand per year. Furthermore, patients we currently treat are more complex, meaning the easier cases will add little complexity and work to our Reference Center. The problem in Brazil is not where to treat, nor how to treat, but how to diagnose patients with the mild disease so they can benefit from the treatment, he explains.

About Brazils goal to eliminate the disease until 2030, hepatologist says it is still soon to ensure this goals viability, but admits the Country has a challenge to increase access to diagnostic, once this rate, despite growing, is still below expected. To him, implementing quick tests in the Unified Health System (SUS) could expand the service in Basic Assistance. Hepatitis C elimination can happen when diagnostic and treatment are available in Basic Assistance, restraining patients with the mild disease, he adds.

Current hepatitis situation

It is expected that in Brazil, around 1.4 million people carry the disease, from which only 20% were diagnosed. New hepatitis C cases are currently rare and restricted to some risk groups, but even though, patients who acquired the disease in the 60s, 70s, 80s and early 90s are being diagnosed. To Dr. Paraná, the great challenge is to deal with an asymptomatic disease that must be tracked by all physicians, regardless of their specialty. Until we establish a universal anti-HCV tracking culture for our population, especially for those above 50 years-old, we will have trouble widening diagnostic access and, thus, to treatment, he alerts.

The physician also stresses the valuable progress presented in the diseases confrontation, since establishing the National Viral Hepatitis Program, in 2003. We still have many problems regarding the hepatitis (C, B and D), as well as we must become familiar to hepatitis E reality. To him, the hepatitis C issue has been solved with the current guideline and should have its scope of therapy options increased in a near future, with new therapy schemes, especially those that redeem patients unresponsive to the current scheme. On the other hand, there is the challenge to confront hepatitis B, and overall, hepatitis Delta, in the more remote regions. These are the challenges we present to the Countrys health authorities, but also to the medical specialty societies (Infectology, Tropical Medicine and Hepatology), he stresses.…