In Russia, the availability of hepatitis C therapy may sharply decrease

The availability of therapy for chronic hepatitis C, which today cannot be called satisfactory, may significantly decrease. To such an extent that many patients with this dangerous infection may be deprived of the right to receive expensive medicines at the expense of compulsory medical insurance until irreversible changes occur in their liver. This will happen if the order, which is undergoing public discussion until February 23, is approved and it enters into force. Patients and doctors are outraged. Several patient communities immediately wrote appeals to the government about this.

After the world learned to completely cure hepatitis C, the World Health Organization adopted a strategy according to which the deadly virus should disappear from the face of the earth by 2030. The strategy was ratified by Russia in 2017 – since then, the country has begun to gradually move towards the goal of eliminating (or eliminating) this virus.

For a long time, the availability of modern drugs that can completely cure hepatitis C in the country remained extremely low. But in recent years, the situation has begun to slowly improve: the list of drugs has grown significantly, patients have a choice, and doctors have the opportunity to choose a treatment depending on the condition of a particular patient. However, according to experts, the new criteria outlined in the order “On Approval of the Criteria for Providing Medical Care to Patients with Hepatitis C in a Day Hospital and inpatient Conditions in Accordance with Clinical Recommendations, which is paid for at the Compulsory Medical Insurance Fund”, cross out all these advances and will set back medical care for patients with chronic hepatitis C by 5-7 years, when old and dangerous complications without interferon treatment regimens were used. Without adequate treatment, chronic hepatitis C can not only develop into cirrhosis or liver carcinoma, but also increase the risk of complications and death from cardiovascular diseases by 1.5 times, oncological diseases by 4-8 times, and diabetes mellitus by almost 2 times. times, kidney diseases – 4 times.

Patient organizations and specialists are extremely concerned about the potential narrowing of the availability of chronic hepatitis C therapy under the CHI policy. Until now, antiviral treatment was recommended for all patients with chronic hepatitis C, but now the leading criterion for receiving therapy will be severe liver complications (advanced fibrosis and cirrhosis). Patients call this discrimination and a violation of the basic constitutional rights of citizens to medical care. In addition, there are several regions in the country where almost all patients with cirrhosis and severe fibrosis have already received therapy. It turns out that the rest of the infected will have to wait for treatment until their liver begins to literally fall apart.

As the chief freelance infectious disease specialist of the Oryol region, head of the regional hepatological center of the city hospital named after V.I. S.P. Botkina Victoria Adonyeva, it is very important not to be limited to the treatment of patients with advanced stages of liver fibrosis: “Firstly, the maximum number of infected people are people of young working reproductive age, 39-49 years old, who need to give birth to children, work. Secondly, the treatment of hepatitis C in patients without cirrhosis of the liver is most effective. Patients with cirrhosis of the liver, even after being cured of hepatitis C, remain at risk of developing hepatocellular carcinoma and remain under medical supervision. Thirdly, when we talk about an infectious disease, we need to think about solving epidemiological problems. If we cover all patients with therapy, we will be able to solve the problem of reducing morbidity and mortality, in accordance with the instruction of the President of the country. We have a positive example of the Moscow region, where due to the large coverage of therapy, the incidence of hepatitis C has decreased significantly. And if we confine ourselves to treating only seriously ill patients, we will find ourselves in a dead end. We have been discussing for many years that the treatment of severe patients can be covered by the regional budget – there are very few of them. And CHI allows you to treat more patients by dividing them into target groups. We have discussed the problems of expanding the coverage of therapy many times, put emphasis on the need to treat and save those who do not yet have serious problems, preventing their development. In the Oryol region, where we have been actively treating hepatitis C for many years in a row, a small number of patients with advanced liver fibrosis are detected – just over 40 people a year. And we planned to treat about 100 people this year, including those with initial liver fibrosis, in order to prevent further spread of the infection among the young healthy working-age population.”

“Patients with the initial stages of liver fibrosis remain socially active, go to medical institutions, to beauty salons for manicure, tattooing, being sources of infection for other visitors to these institutions. In the future, we will have more patients, including those with cirrhosis of the liver. From the same point of view, first of all, it is necessary to treat patients whose work involves frequent contact with other people (for example, doctors, law enforcement officials). If they are not treated on time, they unwittingly become sources of infection for many people. In addition, the focus on more seriously ill patients creates organizational problems, because even if drugs are available, but in the absence of patients with advanced liver fibrosis at the moment, drugs will be “sticked” in case such patients appear. There are regions in which all patients with cirrhosis of the liver have been cured of hepatitis C. What should they do?” says Vyacheslav Morozov, infectious disease specialist, MD, professor, member of the European Association for the Study of the Liver.

As noted in a letter from a patient organization that supervises patients with viral hepatitis, according to the new criteria, the possibility of receiving free therapy for a disease that can be treated simply is made dependent on the development of irreversible outcomes: “Such unjustified discrimination can lead to the development of life-threatening consequences in a significant part of practically healthy (excluding hepatitis C) patients to date. In the future, this will result in an additional economic and social burden (disability) with the possible development of decompensation, the need for liver transplantation and subsequent lifelong therapy.”

The All-Russian Union of Patients in its letter notes that the criteria proposed by the draft order make it impossible to fulfill the instructions of the President and the Government to eliminate hepatitis C until 2030, as it implies a reduction in the current level of care and denial of therapy to patients with a confirmed diagnosis.

Therefore, doctors and patients propose to expand the criteria for receiving therapy and supplement the list with at least patients with severe concomitant diseases (cardiovascular, cancer, diabetes, etc.); women of childbearing age; everyone who is registered for hepatitis for more than one year; health workers.

Experts remind that there is only one way to defeat hepatitis C: by eliminating the source of infection, that is, by curing all patients. “If you want a historical example, this is how malaria was eradicated in the Soviet Union, curing all patients through house-to-house visits and prescribing antimalarial drugs to all sick people,” says Dr. Morozov. It is now quite difficult to say how feasible the task of defeating hepatitis C is in the context of declining budget spending.