The insidious virus destroys the liver without symptoms and causes cancer. You can get infected by accident

• This means we will see more cases of liver cirrhosis and hepatocellular carcinoma associated with hepatitis C, as well as more deaths from them, experts said.
• They reminded us that the HCV virus is mainly transmitted through contact with infected blood, so tissue damage must occur.
• For example, during a surgical operation, blood transfusion, blood collection, but also during a tattoo, piercing, or manicure, when an injury occurs.

- HCV infection is dangerous because it is asymptomatic for many, many years, and at the same time destroys the liver. Symptoms, if they do occur, are completely non-specific, such as fatigue, drowsiness, impaired concentration, and most of us do not attach importance to them. Therefore, if we do not actively search for this infection, we are not able to detect it earlier - said Prof. Małgorzata Pawłowska, head of the Department of Infectious Diseases and Hepatology at Nicolaus Copernicus University in Toruń. As she pointed out, the consequences of developing HCV are very dangerous - such as cirrhosis and primary liver cancer.

According to data presented by Prof. Krzysztof Tomasiewicz, president of the Polish Society of Epidemiologists and Infectious Disease Physicians, 0.5% of the general population in Poland is infected with the HCV virus, i.e. 145-150 thousand people.

- Of this number, we have only a few percent of detected cases - emphasized the hepatologist and infectious disease specialist. Hepatitis C most often affects people who were infected in the 1990s and 2000s. New infections occur mainly in niche populations - among people using drugs intravenously or intranasally and people in prison.

- Our analysis of data from a large part of the centers treating patients with HCV indicates that they are mostly young people - aged 30-50 - said Prof. Robert Flisiak, head of the Clinic of Infectious Diseases and Hepatology at the Medical University of Białystok.

Dr. Hab. Jerzy Jaroszewicz, Head of the Department and Clinic of Infectious Diseases and Hepatology at the Silesian Medical University in Katowice, reminded that in the case of detection of HCV, it is possible to use very effective antiviral treatment. It allows to eliminate the virus within 8-12 weeks and cure up to 99% of patients from the disease. The therapy is convenient to use, well tolerated and safe.

In undiagnosed and untreated individuals, HCV slowly damages the liver and can lead to cirrhosis and hepatocellular carcinoma. In 2023 alone, approximately 2,100 deaths were recorded due to primary liver cancer and another 2,000 deaths due to cirrhosis caused by HCV. According to Dr. Jaroszwicz, in Poland, as many as 90 percent of patients with liver cancer die within a year of diagnosis. As many as 60 percent of cases of this cancer are caused by the HCV virus.

Prof. Tomasiewicz reminded that the global strategy of the World Health Organization (WHO) concerning HCV assumes a 90% reduction in new cases of hepatitis C by 2030 and a 65% reduction in the number of deaths due to this disease.

However, according to calculations by the Polish HCV Expert Group, if we do not introduce widespread HCV testing in Poland as soon as possible, we will not achieve this goal even by 2050.

- The pillar of the HCV elimination strategy is the active search for infected people, because we can handle the treatment of HCV, because we have access to highly effective therapies, very safe, well-tolerated - said Prof. Pawłowska. As she pointed out, the countries with national HCV screening programs have a chance to implement the WHO strategy.

- We do not have this program yet, even though we have been trying to do it for many, many years,

Prof. Flisiak emphasized that in order to effectively detect HCV and implement the assumptions of the WHO strategy, primary health care physicians (PHC) in Poland should perform approximately 3 million tests for anti-HCV antibodies in the adult patient population every year. This is approximately 1-2 tests per day per primary health care physician.

- This means that in one or two patients per month, or in one in two months - depending on the facility - the test result would be positive - said the specialist. These patients would have to receive a referral to specialist care in order to perform a test confirming chronic HCV infection (HCV RNA).

He recalled that currently, primary care physicians, within the so-called entrusted budget, perform about 80 thousand tests per year and this number does not change. Annually, 3.5-4 thousand people infected with HCV are detected.

- If we continue testing at the same pace as we do now, we will only be able to test all those infected in 500 years. Let me remind you that this year we are celebrating the 1000th anniversary of the establishment of the Polish state - said Dr. Jaroszewicz.

Prof. Flisiak emphasized that, in accordance with the recommendations of the Polish HCV Expert Group, universal testing for HCV should be carried out in primary health care facilities, in hospital emergency departments (EDs) and among prisoners.

- Of course, we would most like to recommend mass screening, as was done in Lithuania. But let's at least start with these three places - he emphasized.

As he explained, Lithuania has achieved great success in combating HCV, because within 2-3 years 80% of the population aged 30-65 were tested there. All people diagnosed with HCV were provided with treatment. According to Prof. Flisiak, this was achieved because primary care physicians received a financial incentive.

Meanwhile, Poland has not even managed to effectively introduce HCV tests among people in prison. "In this respect, we are behind Europe," assessed Prof. Tomasiewicz.

Experts pointed out that in the case of mass testing for HCV, the cost of a single cassette test would be small - approximately PLN 5.

They noted that they count on a certain increase in the number of HCV tests in connection with the introduction of the preventive programme "My Health", the aim of which is to conduct preventive examinations in adult Poles from the age of 20.

In their opinion, due to certain limitations, it will not replace mass screening tests that should be conducted as part of the National HCV Elimination Programme.

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