Uniform national practices needed in hepatitis C prevention
There is a need for a Current Care guideline on the treatment of hepatitis C infection. It would contribute to more uniform national practices of diagnostics, treatment assessment, monitoring and therapy. Finland aims to prevent new hepatitis C infections and provide monitoring and treatment for all infected persons. For this purpose a national treatment register is needed. It could be used to predict treatment needs, evaluate treatment chains and monitor the quality and effectiveness of therapies. In the long term all patients infected with hepatitis C virus (HCV) would receive treatment regardless of the degree of liver damage, according to Finland’s new strategy on hepatitis C which was published on 21 November 2016.
Towards uniform national practices
The strategy on hepatitis C emphasises that people with hepatitis C infection must have equal access to treatment. A national treatment register is needed for the monitoring of quality and effectiveness of therapies. Clinical practices must be harmonised at national level. The same applies to access to treatment. Revisions to the care guidelines and more widespread use of new expensive antiviral drugs will multiply the funding needed for hepatitis C therapies. The strategy proposes that costs of new antiviral drugs could be curbed by centralised procurements. More extensive prevention, more efficient testing and the establishment and upkeep of a treatment register will also require funding.
Hepatitis C infections can and should be prevented
The strategy lists a number of ways to prevent hepatitis C infections. Prevention measures should be targeted primarily at higher risk populations, i.e. people who inject drugs and prisoners. It is important to raise awareness of the risks of sharing needles, to provide clean injection equipment to people who inject drugs and to provide substitution therapies. Access to opioid substitution therapy must be ensured nationwide: currently there are great regional differences in access to treatment. There must be more and higher quality low-threshold health services for drug users, and drug users must be involved in the planning and implementation of services. Successful prevention consists of a clear clinical pathway from testing to treatment assessment and therapy. Access to testing and testing methods should be harmonised across the country, and accessible testing should be available to all.
Hepatitis C infection is treatable, but new antiviral drugs are still expensive
The traditional hepatitis C treatment with interferon is still the most commonly used form of therapy in Finland. The new expensive antiviral drugs are used if the current therapy is not effective and liver damage is progressing or if there is contraindication for interferon therapy and the liver damage is severe. In future, patients who have a contraindication for interferon therapy must be referred to assessment of the degree of liver damage. The new antiviral drugs could be used in such cases if the liver disease is advanced and the patient is motivated.
The actual number of infected people is underestimated
Hepatitis C is a liver condition caused by hepatitis C virus (HCV). The main route of transmission is intravenous drug use. One in four drug users are infected with hepatitis C within two years of starting to inject drugs and more than half of them within five years. Since half of the new infections are diagnosed among young adults, there is a great risk of lifelong liver damage and further transmission of the virus.
Chronic hepatitis C causes ongoing liver inflammation that in the long run leads to scarring and at worst to cirrhosis and liver failure. It also increases the risk of liver cancer. There are nearly 30,000 diagnosed cases of hepatitis C infection, and more than 1,100 new infections are diagnosed every year. It is estimated that some 20,000 people carry the virus. Hepatitis C infection is usually asymptomatic in the acute phase, and therefore it is likely that the actual number of infected people and people with chronic hepatitis C is higher than estimated.
Sari Ekholm, Senior Medical Officer, Ministry of Social Affairs and Health, tel. +358 2951 63447
Markku Kuusi, Chief Physician, National Institute for Health and Welfare, tel. +358 2952 48935
Henrikki Brummer-Korvenkontio, Research Manager, National Institute for Health and Welfare, tel. +358 2952 48455