Hepatitis C cure rate of more than 90%, new drug insurance access is urgently needed to accelerate

Medical Network May 31, Today, hepatitis C is still one of the most harmful infectious diseases in the world. According to WHO statistics, about 399,000 people die every year from hepatitis C. Among them, cirrhosis and hepatocellular carcinoma are the main causes of death in patients with chronic hepatitis C. The incidence of hepatitis C in China has also increased year by year, and a large number of patients have not yet been discovered.

Professor Wang Guiqiang, director of the Department of Infectious Diseases at Peking University First Hospital and director of the Center for Liver Diseases, and director of the Center for Infectious and Liver Diseases at Peking University, pointed out the severe situation of hepatitis C prevention and treatment: "Due to the unique concealment of liver disease, many patients do not know that they have hepatitis C. Therefore, screening hepatitis C and finding patients with hepatitis C is the first challenge we face."

Active screening for high-risk groups

According to the World Health Organization, there were 71 million patients with chronic hepatitis C in 2015, and the number of hepatitis C patients in China was close to 10 million. According to the infectious disease epidemic data of the Health and Welfare Bureau of the Health and Family Planning Bureau, the number of Chinese hepatitis C patients increased to 2.3 times in the 10 years from 2007 to 2017. In this regard, Wang Guiqiang pointed out that although there are about 10 million hepatitis C patients in China, in fact, there are not many patients in the clinic.

"This is because most patients do not find themselves sick. Liver disease is clinically known as a silent killer. Chronic hepatitis C does not have any clinical manifestations at an early stage, which leads to late detection, late medical treatment, and about 80% of infected people. Until the development of cirrhosis decompensation, liver cancer was discovered." Wang Guiqiang pointed out that the concealment of liver disease is one of the main reasons for the high mortality associated with hepatitis C virus infection.

"In China, liver cancer is mainly caused by hepatitis B and hepatitis C, of ​​which liver cancer caused by hepatitis B accounts for 10%, and liver cancer caused by hepatitis C is as high as 80%. But unfortunately, many patients with hepatitis C have developed cirrhosis or For liver cancer, the cost of treatment is greatly increased, especially in patients with decompensated cirrhosis. If not treated in time, there is only 25% survival rate in five years. Therefore, we emphasize early screening, early diagnosis and early treatment, which is in the prevention and treatment of hepatitis C. is crucial."

According to statistics, while the number of deaths from infectious diseases such as tuberculosis, AIDS and malaria has dropped, the number of deaths from viral hepatitis has risen against the trend. Between 2000 and 2015, the number of people dying from viral hepatitis worldwide increased by 22% to 134 people per 10,000, exceeding the number of people dying from AIDS.

In this regard, Wang Guiqiang pointed out: "We must promptly discover patients, actively monitor high-risk groups, actively promote publicity through the media and medical institutions, and actively screen high-risk groups." He suggested that there should be a history of blood transfusion and blood donation in the 1990s and before. There are high-risk sexual behaviors, history of intravenous drug addiction and other high-risk groups of blood exposure for "carpet-style" screening, family members of patients with hepatitis C, AIDS and other diseases should also be covered.

Urgent need for antiviral drugs into medical insurance

With the emergence of small anti-viral drugs, the cure rate of hepatitis C has reached more than 90% in recent years, and some of them have almost 100% cure. Wang Guiqiang said that the genotype of patients needs to be determined by genetic testing. "Different genotypes have different treatments and different infection pathways. In China, gene type 1b may be caused by blood transfusions such as blood transfusion, and most of gene type 3 It is a drug-using population, and many infected people are mixed, which means that they are infected many times. At present, the most important genotype in China is gene type 1b, accounting for 56.8%."

Wang Guiqiang also pointed out that to achieve individualized medical treatment, it is not possible to use only genetic testing for classification. Instead, comprehensive consideration should be given to individualized diagnosis and treatment from the aspects of genotype, cirrhosis background, drug interaction and other concomitant diseases. Individualized treatment emphasizes individualized evaluation of each patient to give the best treatment.

He also mentioned the availability of drugs. "Whether medical insurance can pay for medicines, and patients can afford it. It is also necessary for us to consider. The current price of small molecule antiviral drugs is generally high, and many patients cannot afford it. This is in urgent need of support at the national level."

Wang Guiqiang suggested that medical insurance should cover hepatitis C drugs to solve the problem of drug accessibility: "According to the current national medical insurance policy, clear and effective drugs should be included in the basic drug list and medical insurance catalog, and the cure rate is close to 100% of hepatitis C. This is especially true for antiviral drugs. The state should come up with a price-balance problem to bring hepatitis C drugs into health care and purchases , and call on companies to lower prices to cover more people."