Russia loses in the fight against hepatitis C

Russia loses in the fight against hepatitis C



Moving towards the goal of elimination (destruction) of viral hepatitis by 2030 set by the World Health Organization, Russia is falling further and further behind it. Today, only 1% of the identified patients with chronic hepatitis C are provided with therapy in the country, and the situation, apparently, will not move from a dead point - the draft budget for 2023 in the country again does not provide funds for drug provision of such patients. Experts announced this during the XIII All-Russian Congress of Patients that opened in Moscow.

According to the WHO, 1.5 million new cases of chronic viral hepatitis C (CHC) and more than 300,000 deaths are registered annually in the world. In Russia, between 3.5 and 4.7 million people are infected with hepatitis C, which puts the country in sixth place in the world in terms of its prevalence.

Back in 2016, Russia signed the WHO strategy to eliminate viral hepatitis by 2030. Last year, the Russian president called for urgent measures to reduce the prevalence of this infection, and in September 2022 he ordered to ensure the implementation of a set of measures aimed at combating hepatitis C. On November 2, the Russian Federation adopted a national action plan to combat viral hepatitis C. He provides for effective measures to prevent transmission of the virus, expanding access to testing and treatment. However, the draft federal budget of the country for the coming three years does not provide for the allocation of funding for additional measures to combat chronic viral hepatitis C in accordance with this plan.

As a result, only about 1% of patients out of more than 626 thousand patients receive treatment every year. Experts note that at such a rate, the incidence of hepatitis C cannot only be eliminated, but simply stopped.

As the co-chairman of the All-Russian Union of Patients Yuri Zhulev said, unfortunately, the implementation of measures to combat hepatitis C is expected only at the expense of the approved budget: "But we do not see an expansion of patients' access to modern therapy, the availability of therapy is minimal. Therefore, we will not be able to fulfill the tasks of eliminating hepatitis C. For example, patients with hemophilia, most of whom are infected with the hepatitis C virus through blood products, are completely inaccessible in many regions - they are forced to look for money to pay for treatment, although it is the social responsibility of the state to treat them. treatment coverage of patients.

According to the chief infectiologist of the country, professor of the Department of Infectious Diseases of the Medical and Preventive Faculty of the First Moscow State Medical University named after I.M. Sechenov Vladimir Chulanov, the WHO strategy set an ambitious goal to reduce the number of detected cases of CVHC by 2030 from 1.5 million to 350 thousand cases, and to halve the number of deaths due to CVHC (to 140 thousand): "In 2009, we had a peak incidence (41 cases per 100 thousand of the population), by 2021 it was possible to reduce the numbers to 31 cases. However, the mortality statistics among patients with chronic hepatitis C are not very accurate, because often these people die of cirrhosis and liver cancer as a result of hepatitis C, therefore, deaths due to diseases are listed Gastrointestinal tract or oncology.Indirect estimates show that the mortality among patients with viral hepatitis C is growing in our country.In 2021, the number of people treated with us was about 20,000 people, and 24,000 new cases are detected annually, that is, there is an accumulation of patients. Obviously, the availability of treatment needs to be significantly increased, especially since today there are direct antiviral drugs that allow you to completely cure m of hepatitis C, which reduces the risks of cirrhosis and cancer treatment".

The availability of treatment in Russia is low because effective drugs are not cheap. However, experts have calculated that curing patients will be much cheaper than the losses that the country will suffer if they are not treated. International and domestic studies show that among patients with chronic viral hepatitis aged 16 to 55 years, the number of patients with more than one chronic disease is 2-5 times higher than the corresponding figure among non-infected hepatitis viruses. Chronic viral hepatitis 2-4 times increases the incidence of various malignancies, not including liver cancer, is one of the causes of type II diabetes, and 2 times increases the incidence of cardiovascular events. Cure of chronic hepatitis C reduces the risk of cardiovascular events by 43%.

Nikolai Avksentiev, adviser to the director of the NIFI of the Ministry of Finance of the Russian Federation, researcher at the IPEI RANEPA, presented research data on the cost of hepatitis C in terms of money and demographic indicators and why it is beneficial to eliminate the infection as soon as possible. According to the study, chronic hepatitis C causes 17,000 preventable deaths per year and reduces life expectancy in the country by 0.17 years annually. The annual decline in the working-age population due to chronic hepatitis C is 4,000 people per 100,000 people per year. If nothing is done, the contribution will grow. “The elimination of hepatitis C would be more effective in reducing the death rate of the working population than the implementation of measures to combat cancer and programs to reduce road injuries. If nothing is done, by 2030, deaths due to this disease will increase by 2035 from 17 thousand up to 30,000 per year. By implementing the elimination program, we will be able to reduce mortality to 5,000 per year, increase life expectancy in the country by 0.44 years, save 240,000 lives and receive 1.3 billion rubles as an economic benefit. But investments are needed in the diagnosis and treatment of patients in order to obtain a long-term cumulative effect," says the expert.

In the meantime, the situation with diagnosis and treatment is highly dependent on the regions. Some are doing well, while others have not treated a single patient at all. In the Samara region, they took the path of microelimination - they allocate small dispensary groups of patients, on whom they throw all their strength. As Elena Strebkova, the chief infectious disease specialist of the region, said, at first it was possible to achieve complete elimination of hepatitis C in adolescents. Then they began to massively treat patients with HIV coinfection (historically, in the 90s, the Samara region was the center of drug trafficking, so there are many such patients here). Now the task has been set to treat all children aged 3-12 years (there were no drugs for them before, but now they are registered); followed by dialysis patients. “It’s easier to get money for a specific program and target group than to demand it at once for everyone. We have chosen this path and hope that we will gradually increase the number of treated patients. In addition, we have secured funding for the purchase of devices for elastometry - this study helps to determine the degree of liver damage and competently prescribe therapy. So far, patients can only undergo it for a fee. And yet, out of 5,600 patients in need of therapy, only 133 people receive it, the rest are waiting. elimination," says Elena Strebkova.

The chairman of the board of the patient organization, Nikita Kovalenko, notes that state spending on the treatment of patients with chronic hepatitis C has begun to grow in recent years, but the pace of treatment still lags behind the number of new cases per year: “Current spending is not enough to simply contain the incidence. According to surveys among patients , 48% have known about the disease for more than 10 years, but 68% have never tried to cure hepatitis C. Additional measures are needed, otherwise we will not cope with hepatitis - but it will cope with us.”



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