São Paulo, November 23, 2017.
Excellency Mrs.
Dr. Adele Benzaken
Head
mistress
Department
on STI, AIDS and Viral Hepatitis – DIAHV
Ministry
of Health
Brasília –
DF
Dear Mrs.
Benzaken,
During the 11° Congress on HIV/AIDS and the 4°
Congress on Viral Hepatitis, held from September 26th to 29th, 2017, in
Curitiba, the DIAHV reported a new estimating from the result of 0,7% HCV- positive screening cases, summarized on
the chart below:
Estimated Prevalence of People Living with
Hepatitis C age 15 – 69 (2016)
Antibody
Prevalence
|
0,7%
|
Total Infected
|
1.032.000
|
Viremic Prevalence
|
60,7% of previous ones
|
Viremic Cases
|
656.000
|
During the same Congress, it was reported estimated cases by disease
stage, frameworked below:
Estimating Distribution by Stage of Disease
|
||
2016
|
2017
|
|
F0
|
116.368
|
108.462
|
F1
|
226.395
|
217.381
|
F2
|
124.731
|
116.793
|
F3
|
112.842
|
110.148
|
F4 (cirrhosis)
|
69.795
|
69.208
|
Descompensated
cirrhosis
|
3.161
|
3.125
|
Hepatocarcinoma
|
1.685
|
1.643
|
Related
deaths
|
2.334
|
2.310
|
Total
|
657.311
|
627.070
|
Also,
according to the Epidemiological Bulletin on Viral Hepatitis 2017 (page 21) there are,
from 2007 to 2016, 149.537 confirmed cases of hepatitis C, of which 9,8% correspond
to HIV coinfection, it means 14.654 people.
It
is relevant to observe that the information reported on 07/27/2017, World
Hepatitis Day’s eve, that the Ministry
of Health estimated that in the near future 135.000 patients with hepatitis C
would receive treatment in order to provide treatment for everyone. This number
does not match with the number of prevalence cases (656.000 patients who need
treatment) disclosed in Curitiba. We cannot agree with the optimistic egregore surrounding
the report that announces ceasing the queues for patients on the F3 and F4 stage, since
they are about 180.000 people, estimated by the sample above.
The
next chart presents the database of treatments with DAAs, kindly provided by
this Department and by the State of São Paulo Programme on Viral Hepatitis.
Local
|
Total
|
HIV-Hep. C Coinfected
|
City of São Paulo
|
7.185 (09/18/2017)
|
1.031 (09/18/2017) (14,4%)
|
State of São Paulo
|
23.466 (09/18/2017)
|
3.070 (09/18/2017) (13,1%)
|
Brazil
|
57.080 (until the third trimester)
|
3.649 (07/03/2017) (6,4%)
|
The
DIAHV also reported that from October 15th on, it would be made available
25.000 new treatments.
Thus,
it is obvious that most of the coinfection treatments were provided to the State of São Paulo, in a
over 70% ratio, that does not correspond neither to the State population
comparing to Brazilian population, nor to the people coinfection ratio in
Brazil. That shows the necessity of more state and municipal campaigns in order
to accelerate better distribution and coverage. In fact, more than 14.000 cases
of confection have been diagnosed, although the treatments accumulated since
October 2015 were less than 4.000 ones. Since all those people probably are attended
HIV health programmes, it is necessary and possible to increase the amount of treatments
rapidly.
The
proportion of treatment for coinfected patients comparing to the monoinfected
by Hepatitis C in Brazil and in the State of São Paulo also is worth of
attention. It doubles the proportion when it comes to the city and State of São
Paulo comparing to Brazil, with 41% total ratio. It causes surprise since the
treatment for monoinfected individuals depends on fibroscan testing, not
available in every healthcare service, unlike the treatment for coinfected
individuals. It is important to highlight that the HCV screening and diagnosis
is fundamentally an attribute of States and Municipalities.
The
Brazilian Government purchases the medicines at too high prices, that justifies
the barriers on the treatment, that selects individuals by fibrosis stages or other
issues. On the other hand, other developing countries offer universal treatment
for Hepatitis C. Egypt has already offered treatment for over 1,4 million
individuals currently paying less than U$ 180 per treatment. Malaysia has
enacted compulsory licence for government use and probably will spend less than
U$ 300 per treatment.
Therefore,
we request from this Ministry that:
1.
Intercede
with the States and Municipalities on the treatment of individuals with
Hepatitis C and HIV;
2.
Head campaigns
for diagnosis and treatment of people in stage F2 or more advanced.
3.
Get more
advantageous prices, like so many other developing countries, to treat people
with Hepatitis C, using the safeguards set out in our Patent Law 9279 and the
TRIPS Agreement;
4.
Refrain
from spreading utopian news as “queues zero”, when in fact what is happening is
the failure on diagnosis and access to healthcare, and starting requesting
Brazilian people to undergo HCV tests.
Cordially,
Rodrigo Pinheiro Claudio
Pereira Paulo Giacomini
FOAESP GIV RNP+SP
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