by Chiara Daina
Since there is no vaccine against this pathology, screening is essential. If discovered in time, the disease can be cured in a few weeks; if allowed to progress it can lead to cirrhosis and liver cancer
Hepatitis C is a viral infection that can remain dormant for a long time, slowly compromising the liver. In most cases the disease is asymptomatic (or non-specific symptoms such as tiredness and digestive difficulties) for 10-20 years, up to its most advanced stages (cirrhosis and liver failure). The screening test is the only tool to find hidden cases, those still undiagnosed, which according to estimates in Italy are around 300 thousand, and consequently limit infections and new infections explains Massimo Andreoni, professor of infectious diseases at Tor Vergata University of Rome and scientific director of the Italian Society of Infectious and Tropical Diseases. The free national screening program, launched in 2022 thanks to an ad hoc fund, was extended until the end of 2024 with a State-Regions agreement last December.
Free national screening
The screening is aimed at those born between 1969 and 1989, as well as users of the Addiction Services (SERD) and prisoners in prison regardless of the year of birth. The Ministry of Health is also working to include generations born between 1948 and 1968. But in some regions the prevention campaign is still waiting to start (Sardinia, Puglia, Abruzzo and Calabria) or has only started for prisoners and Serd users (Trento, Sicily, Valle D’Aosta).
Since there is no vaccine against hepatitis C, screening is fundamental: If the disease is discovered in time, it is possible to cure it, avoiding the development of serious complications and the use of a transplant, with a reduction in deaths and significant savings for public health – he clarifies Andreoni —. Furthermore, only with screening is it possible to achieve the objective of eliminating the HCV virus set by 2030 by the World Health Organization strategy to which Italy has joined.
How to participate in the screening
The ASL can send the invitation to participate in the test via letter by ordinary mail, text message on mobile phone or electronic health record, depending on the regional organization. The invitation generally indicates the structures to contact. Even those who do not receive it can still go to the sampling center of their healthcare company (or to the offices of the voluntary associations participating in the campaign) and request the free test. Reservations are not always required and a doctor’s prescription is not required. The screening methods proposed for the search for anti-HCV antibodies (the virus responsible for the disease) are standard blood sampling or fingerstick testing (taking a drop of blood from the finger). The test can also be offered during other laboratory investigations or during a hospital stay.
In case of positivity, a further confirmatory test will be carried out to identify the viral RNA. If the person has an active infection they will be referred to the relevant specialist center to begin treatment. good rule – recalls Alessandro Rossi, family doctor president of the Italian Society of General Medicine – always undergo a test for hepatitis C in case of high levels of transaminases, enzymes which if higher than normal can indicate inflammation or damage of the cells of the liver.
Hepatitis C therapy
When chronic HCV infection, if left untreated, causes liver fibrosis which leads to cirrhosis, a condition that can lead to impaired liver function and the risk of developing liver cancer. Collateral complications may also arise, such as renal failure, lymphoma, diabetes, cognitive and cardiovascular disorders. The earlier treatment is started, the less damage there is. Treatment lasts 8-12 weeks. But if the cirrhosis is already very advanced, the only solution is a transplant, Andreoni points out.
How the hepatitis C virus is transmitted
The hepatitis C virus is mainly transmitted parenterally, i.e. through means of contagion of infected blood. These are mainly needles and syringes that are exchanged for the injection of drugs and other tools reused to dissolve and inhale powdered substances from the nose, the mucous membranes of which can present micro-lesions with consequent blood residues, even invisible ones – clarifies Massimo Andreoni, Professor of Infectious Diseases at the Tor Vergata University of Rome and scientific director of the Italian Society of Infectious and Tropical Diseases. Once upon a time, the transmission of the virus also occurred through transfusions from infected donors and invasive non-sterile healthcare interventions, a phenomenon which today, thanks to controls, has almost disappeared. Vehicles of contagion can also be manicure and pedicure instruments and those for tattooing and piercing, when non-sterilized equipment is used.
Symptoms of hepatitis C
More rarely, transmission between cohabiting family members is possible, through the sharing of scissors, razors and toothbrushes, sexual transmission and vertical transmission from mother to child. The categories most exposed to the risk of contagion are drug addicts, those who have other concomitant infections, for example HIV or other types of hepatitis, immunosuppressed people and those living with people with HCV, clarifies Andreoni. Once the infection has been contracted, in 30 percent of cases it resolves spontaneously but in the remaining 70 percent the virus remains active and causes slow and progressive damage to the liver – highlights Alessandro Bartoloni, professor of Infectious Diseases at the University of Florence -. The initial symptoms, when present, appear after an incubation period ranging from 2 weeks to 6 months, and consist of tiredness, loss of appetite, nausea, slight increase in body temperature, abdominal pain, jaundice and dark urine. In these cases it is best to contact your family doctor to investigate the possible causes.
In Italy 400 thousand people are infected and half are not aware of it
As of 30 June 2023, the Ministry of Health reports, thanks to the national screening campaign that started in 2022, 966,498 people were tested for hepatitis C and approximately 10 thousand cases of active infection were identified, of which: 1,302 among those born since 1969 in 1989, 7,029 among Serd users and 1,650 among prisoners. The WHO estimates that there are 58 million people affected by chronic hepatitis C worldwide, of which 14 in Europe, and approximately 1.5 new cases of infection per year. In our country the incidence of new cases of symptomatic HCV that are diagnosed is around 0.1 per 100 thousand inhabitants. But there would be at least 400 thousand infected subjects according to the most recent estimates: of these, more than half (about 287 thousand) are not aware of having the disease and have no symptoms (the hidden undiagnosed one) and approximately 100 thousand people already have liver fibrosis ( caused by the HCV virus) in a very advanced stage.
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January 24, 2024 (modified January 24, 2024 | 08:19)
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