Do you know how much effort China has put into curbing the "silent killer" hepatitis C?

Three scientists won the Nobel Prize for discovering the hepatitis C virus. What kind of virus is this? What is the current situation of hepatitis C in China? What measures has China taken to fight hepatitis C?

Written by Feng Xiaohong (Medical and Health Group)

New Media Editor/Chen Xuanzhi

On October 5, 2020, at around 17:30 Beijing time, American virologist Harvey J. Alter, British virologist Michael Houghton and American virologist Charles M. Rice won the 2020 Nobel Prize in Physiology or Medicine for their discovery of hepatitis C virus (HCV).

▲Three scientists won the 2020 Nobel Prize in Physiology or Medicine for discovering the hepatitis C virus (Image source: Nobel Prize official website)

This is a landmark discovery in the fight against viral diseases. Thanks to their discovery, highly sensitive blood tests for the virus have now been made possible, eliminating post-transfusion hepatitis in many parts of the world, greatly improving global health. Their discovery also enabled the rapid development of antiviral drugs for hepatitis C. For the first time in history, hepatitis C has been cured, bringing hope for the eradication of the hepatitis C virus.

What exactly is hepatitis C virus? What is the current situation of hepatitis C in China? What measures has China taken to combat hepatitis C virus?

What is the current situation of Hepatitis C in China?

People's understanding of hepatitis C virus began in the 1970s. At that time, Harvey James Alter discovered a new type of chronic hepatitis transmitted through blood transfusion. The cause of this hepatitis was neither hepatitis A virus nor hepatitis B virus. In the following 10 years, biologists tried to isolate this hepatitis virus from patients, but to no avail. In 1989, a research team led by Michael Horton of Chiron Pharmaceuticals in the United States finally identified the hepatitis C virus with the help of a new molecular biology technology.

Hepatitis caused by this virus is a global epidemic, and people of different genders, ages, and races are all susceptible to hepatitis C virus. Once it takes root in the human body, this chronic disease can lurk in the body for decades, and many patients may not show symptoms. Without knowing it, 10%-20% of patients will develop hepatitis C into cirrhosis, liver failure, or liver cancer.

▲Schematic diagram of hepatitis C virus (picture from the Internet)

In China, when talking about hepatitis, most people's first reaction is "hepatitis B", and they don't pay attention to its sister "hepatitis C". A public survey conducted by the China Hepatitis Prevention and Control Foundation in recent years showed that only 38% of people have heard of hepatitis C, which is far lower than the knowledge of hepatitis A (91%) and hepatitis B (95%). In fact, China is currently the country with the largest number of people infected with the hepatitis C virus, and it is showing a trend of increasing year by year.

In an interview with the media, Zhuang Hui, an academician of the Chinese Academy of Engineering and the drafter of China's first "Guidelines for the Prevention and Treatment of Hepatitis C", said that in recent years, the number of reported cases of hepatitis C has increased more than 10 times, from 21,000 in 2003 to 230,000 in 2016. According to statistics, there are about 7.6 million people infected with hepatitis C virus in China, and the number of reported hepatitis C cases in the past five years has exceeded 200,000 per year.

At present, the reported cases of hepatitis C patients in my country are mainly people over 30 years old. However, there is still a lack of systematic hepatitis C monitoring data. Researchers selected 187 articles from 12,836 Chinese and 7,165 English articles published by different regions and research groups and found that the infection rate of intravenous drug users in my country is 48.67%-87.54%; the hepatitis C antibody positive rate of hemodialysis people is between 5.52%-7.67%; in 2011, 3.83 million gay men in my country were infected with hepatitis C through damaged skin and mucous membranes.

In addition, data show that only 1.3% of all infected people in my country receive treatment for chronic hepatitis C. Wei Lai, director of the Hepatobiliary and Pancreatic Center of Beijing Tsinghua Chang Gung Hospital affiliated to Tsinghua University, said in an interview with the media: "70% of patients do not receive anti-hepatitis C virus testing until they present with obvious clinical symptoms, and about 10% of the patients who are initially diagnosed have already developed liver cirrhosis."

Academician Zhuang Hui said in an interview with the media that if hepatitis C is not treated promptly and correctly, the incidence of liver cirrhosis will reach 30% and the incidence of liver cancer will reach 20% after 15 years. Once liver cirrhosis and decompensation occur, the patient's 10-year survival rate is only 25%, and the probability of death from liver cancer in the first year after diagnosis is 33%. According to statistics, the number of deaths from liver cancer in China is about 360,000 per year, of which the mortality rate of liver cancer secondary to hepatitis C accounts for 37.48%, and it is showing a rapid upward trend.

What measures has China taken to combat hepatitis C?

The task of controlling hepatitis C is very difficult, and China has never underestimated this "enemy" of hepatitis C. Through the efforts of all parties, my country has made great achievements in the screening, diagnosis, prevention and control of hepatitis C.

In 1991, my country successfully developed the first generation of hepatitis C antibody detection methods, which were approved for screening blood donors two years later. Since then, blood-borne hepatitis C has dropped significantly. The following year, experts used the reverse transcription-DNA amplification method to analyze the hepatitis C virus genotype in Chinese people, laying the foundation for subsequent research.

From 1995 to 2000, diagnostic reagents for hepatitis C were introduced. During this period, experts successively developed the first generation of domestic anti-hepatitis C virus nucleic acid test kits, and the second and third generation anti-hepatitis C virus test kits, which were successfully used to screen hepatitis C patients and blood donors. In 2000, Wei Lai, as the person in charge of the "Eleventh Five-Year Plan" scientific and technological research, led the team to find the pathogenesis of hepatitis C patients in China. They found that if the infection is not treated, it will evolve into liver cancer in 20-30 years.

Based on the research in the past 10 years, the guidelines of the liver disease community in my country were released. In 2004, experts compiled the first "Guidelines for Hepatitis C" in my country. Ten years later, the national health authorities issued "Screening and Management of Hepatitis C Virus", which clarified the high-risk groups for hepatitis C screening and the screening time.

In order to comprehensively curb hepatitis C, in recent years, multiple departments have jointly issued the "China Viral Hepatitis Prevention and Control Plan (2017-2020)", which further clarified the work tasks, namely, by 2020, the national overall hepatitis C virus detection rate in blood stations will reach 100%, and it also proposed to include hepatitis C testing in the category of physical examinations, and provide necessary diagnosis and antiviral treatment and other related services to those who are found to be positive for hepatitis C virus.

In addition, according to the overall goal of "eliminating viral hepatitis by 2030" set by the World Health Organization at the 69th World Health Assembly (reducing the new infection rate by 90% and the mortality rate by 65%. To eliminate viral hepatitis, more than 90% of infected people need to be diagnosed and more than 80% of confirmed patients need to be treated), the Central Committee of the China Democratic League also suggested the promulgation of the "Viral Hepatitis Prevention and Control Plan (2020-2030)" to further improve the screening, diagnosis and treatment rates of hepatitis C.

Hepatitis C treatment options in China

Hepatitis C is divided into different genotypes, and the treatment methods for different genotypes are also different. The main genotypes of hepatitis C virus in my country are 1b and 2a. Currently, the treatment options suitable for Chinese hepatitis C patients mainly include PR, DA, SD, SR, SPR and OPRD. Among them, PR is the main treatment option for hepatitis C in China.

Previously, the traditional PR regimen was pegylated interferon combined with ribavirin (a broad-spectrum antiviral drug), but this "blind man touching an elephant"-style "standard regimen" can cause great side effects, and the treatment cycle is long and the patient's chance of relapse is high. Currently, the latest treatment guidelines no longer recommend the PR regimen. In recent years, with the development and marketing of direct antiviral drugs (DAA), great progress has been made in the treatment of hepatitis C, and the cure rate has been greatly improved.

At present, DAA drugs are accessible in my country. In recent years, relevant Chinese departments have intensively approved the listing of multiple DAA drugs for hepatitis C in China, such as daclatasvir, asunaprevir, simeprevir, sofosbuvir, ombipari, dasabuvir, sofosbuvir velpatasvir tablets, etc. DAA drugs precisely attack the hepatitis C virus, using its related proteins and enzymes as direct drug targets to achieve effective viral inhibition. This drug can increase the cure rate of chronic hepatitis C patients to 90%, or even more than 95%, and shorten the treatment cycle to 12-24 weeks.

Of course, DAA is not a "magic drug". It cannot cure every patient, and a small number of patients still fail to receive treatment. It is understood that patients who have failed treatment in the past account for nearly 5% of the total number of hepatitis C patients. On June 30, Gilead announced that a drug, Sofosfovir, would be launched in China, which can "fill the last gap in the cure of hepatitis C."

At the end of last year, Voswell was approved by the National Medical Products Administration for the treatment of patients who have failed DAA-containing regimens, including adults with chronic hepatitis C virus infection without cirrhosis or with compensated cirrhosis. According to clinical trial results, the efficacy of Voswell for patients with different genotypes is 97%-100%.

▲The cure rate of Sofosbuvir tablets for patients of various genotypes who failed DAA treatment (Image source: Sohu.com)

Vosvir (Sofosvifen tablets) provides Chinese patients with a complete solution to cure hepatitis C, bringing our country one step closer to the goal of completely eliminating hepatitis C. How to find more patients, how to improve the accessibility of drugs, and how to let patients know that there is a complete solution to cure hepatitis C may be the direction of our next efforts.

References:

1.MedSci: Gilead's latest chronic hepatitis C drug "Gen III" Osram is launched in China, curing hepatitis C for less than 100,000 yuan

https://www.medsci.cn/article/show_article.do?id=381719e037b2

2.Alter HJ, Houghton M. Clinical Medical Research Award. Hepatitis C virus and eliminating post-transfusion hepatitis. Nat Med, 2000, 6(10):1082-1086.

3. China Medical Forum WeChat Official Account: Experts Talk About the Road to Hepatitis C Cure (Part 1) | “There is no specific drug for the new coronavirus, but there is for hepatitis C virus.”

4. Scientific Research Circle WeChat Account: They brought the end of hepatitis C! Detailed explanation of the 2020 Nobel Prize in Physiology or Medicine

5. WuXi AppTec Official Account: How has mankind conquered the millennium-old hepatitis C virus over the past 30 years?

6.The Paper: Interpretation: Why were they awarded this year’s Nobel Prize in Physiology or Medicine?

https://www.thepaper.cn/newsDetail_forward_9468393

Produced by: Science Central Kitchen

Produced by: Beijing Science and Technology News | Science Plus Client

Reproduction without authorization is prohibited, and offenders will be prosecuted