An alteration in the interleukin 28B gene allows determining the ability of an individual to fight the hepatitis C virus, both spontaneously and after receiving antiviral treatment.

Hepatitis C is a disease that affects almost 200 million people around the world. In Spain, its incidence ranges between 800,000 and 900,000 people. Although the percentage of patients who have cured of the infection has increased significantly in the last ten years, the disease tends to become chronic very frequently, even in those patients who have been treated correctly. In these cases, liver damage can progress and cause more serious conditions such as cirrhosis or cancer in 5-25% of cases. However, advances in the research of new drugs will facilitate the eradication of the virus because, as stated by Dr. Ricard Solà, head of the Hepatology Section of the Hospital del Mar in Barcelona, "Unlike other viruses, hepatitis C can be cured".

The new and better treatments that are already available today, such as the combination of pegylated interferon + ribavirin, have made it possible to increase "Cure rates of 6-12%, in the 90's, to 66-70% at present", as the specialist indicates. However, the prognosis of those affected has improved even more thanks to a new discovery that will allow predicting the healing possibilities of patients, even before starting treatment.

Until now, multiple factors were known that influenced the healing possibilities of patients with hepatitis C: some who depend on the virus (such as viral load and genotype) and others of the patient himself (the degree of liver damage: fibrosis and metabolic disorders). ). "Analyzing the distribution of these factors, the possibilities of cure vary from 0-10% to 90-100%", explains Dr. Manuel Romero, head of the Digestive Service of the Valme Hospital in Seville.

With these data, the treatment of the disease already tended towards individualization taking into account the differential characteristics according to the possibilities of cure. "But a new factor has changed the history of hepatitis C. The appearance of a single genetic alteration on chromosome 19, in the gene of interleukin 28B, allows us to classify the healing possibilities of a person"says Dr. Romero. "Each of us is born with a genotype in interleukin 28B that allows us to catalog, genetically, the susceptibility and capacity of the organism to defend itself against hepatitis C virus, both spontaneously and after receiving antiviral treatment. Therefore, its analysis determines whether or not you have a predisposition to heal. ", Add.

This review shows the important role of the set of prognostic factors and the need for their analysis to determine which patients should start treatment with therapy (pegylated interferon alfa-2a + Ribavirin) and who should wait for triple therapy. "This technique - Dr. Solá adds - will allow us to select patients who can be cured with interferon plus ribavirin without the need to wait for triple treatment, as the new molecules are effective but apparently will raise the total cost of the treatment. therapy and have side effects that are difficult to manage. The new therapeutic options will offer a very valid alternative; however, it would be a mistake to create false expectations since the benefits-costs and the increase in side effects should be taken into account ".

Alternatives available

Using the most appropriate method based on the response of each patient is the best option available, since it decreases health costs and side effects suffered by patients. "There are people who need "Short treatment", that can last up to 6 months, and that supposes a smaller cost for the National System of Health when being indicated a standard therapy without that this diminishes the probabilities of curing of the illness ", argues Dr. Juan Turnes, medical hepatologist of the Hospital Complex of Pontevedra. "On the other hand, for those patients with greater resistance to treatment, where the virus slowly decreases, it has been proven that its prolongation up to year, year and a half, can mean the cure", adds the expert.

Taking this situation into account and analyzing the current treatment options, it is necessary to look for the most cost-effective strategy to combat hepatitis C. A recent pharmaco-economic study carried out in Spain shows that the combination of pegylated interferon alfa-2a and ribavirin Not only is it more effective, but also less expensive compared to peginterferon alfa-2b plus ribavirin.

"Scientific evidence showed that patients treated with pegylated interferon alfa-2a are 11% more likely to achieve sustained viral response (cure) than those treated with pegylated interferon alfa-2b", says Dr. Turnes. This treatment offers greater benefits, "Both in terms of efficiency, speaking of years of life adjusted for quality of life, as in cost savings", adds the specialist. "So much so," Dr. Turnes continues, "that we can affirm that you can achieve savings of between 700 and 1,900 euros per patient, depending on the genotype of C virus.".

There are great expectations for the future regarding hepatitis C since "There are around 12 molecules in advanced development that can help us achieve cure rates of 80/85% of patients"concludes Dr. Solà.

Hepatitis C and the Cure (November 2019).