Cooperation project successfully combats hepatitis C
A groundbreaking success in the fight against hepatitis C: As part of the cross-institutional ELIMINATE project, hospital data was systematically analyzed in ten hospitals in Vienna (including 6 WIGEV clinics) and Lower Austria in order to identify and treat those affected. As a result, almost 400 patients were cured of their chronic hepatitis C disease using modern therapies.
The results of the project have now been published in the top journal "Liver International". St. Pölten University Hospital, the teaching and research centre of Karl Landsteiner University, played a leading role in the project.
The aim of the "ELIMINation AusTria East" (ELIMINATE) project launched in 2020 was to eliminate hepatitis C in eastern Austria. A team of doctors from the Medical University of Vienna, Ottakring Hospital and St. Pölten University Hospital conducted a large-scale study to this end. The results of this study, led by Lorenz Balcar, Michael Schwarz (both MedUni Vienna), Caroline Schwarz and David Bauer (Wiener Gesundheitsverbund) and Livia Dorn and Andreas Maieron (University Hospital Sankt Pölten, teaching and research site of Karl Landsteiner Private University), have now been published in the journal "Liver International".
Hepatitis C now curable
In the past, chronic hepatitis C was still treated with interferon injections, which sometimes had side effects and could only achieve low cure rates for over a year. Since 2015, potent direct-acting antiviral drugs (so-called "direct acting antivirals": DAAs) with few side effects have been available. These orally administered DAAs enable hepatitis C to be cured within 8 to 12 weeks with almost 100% probability and with almost no side effects. This is why the World Health Organization (WHO) has set the goal of halting and reversing the global increase in hepatitis C-related liver diseases and deaths. However, this requires an increase in diagnosis and treatment rates.
"Regular tests for hepatitis C are carried out in every hospital, e.g. as a screening before operations or in suspected clinical cases. But not every person with a positive virus test result receives antiviral therapy," reports Lorenz Balcar, one of the first authors of the study. There are many reasons for this, adds Michael Schwarz: “Some patients received interferon-based therapy in previous years, but could not be successfully cured. Others rejected the treatment at the time due to the side effects and long duration of therapy. When DAAs came onto the market, the approval criteria were strict and some patients were 'too good' for the therapy. Sometimes it also failed due to the connection to special outpatient clinics, as only certified centers were allowed to prescribe DAA therapy in Austria. And in rare cases, patients didn't even know about their hepatitis C infection.”
Broad collaboration for successful elimination
"For ELIMINATE, crutches were turned into stilts and precisely this problem of 'forgotten' hepatitis C PCRs was used as the basis for a macroelimination project," explains co-study leader Caroline Schwarz from Klinik Ottakring (WIGEV), who had previously published the interim report of the ELIMINATE project. As part of the ELIMINATE project, all positive hepatitis C results (PCRs) from the years 2008 to 2020 were systematically evaluated in ten hospitals in Vienna and Lower Austria in order to identify patients who could potentially still be suffering from chronic hepatitis C. These people were contacted and invited for a check-up.
Of the 5,695 patients identified, a significant proportion had already died or had completed treatment at other centers. Antiviral therapy was administered to 397 of the 617 patients reached, of whom a documented 82.1% have since been cured. "However, due to the high efficiency of the drugs of around 99%, the cure rate is probably even higher," notes co-study leader Livia Dorn from the University Hospital of St. Pölten. And co-study leader David Bauer adds: “It was striking that a third of the patients had already died by the time the data was collected, which underlines the medical problems of this chronic disease on the one hand, but also often the difficult socio-economic circumstances of the people affected.”
A role model for future projects
The ELIMINATE project impressively demonstrates how great progress can be made in public health through cooperation and the use of simple means. Co-study leader Andreas Maieron from the University Hospital Sankt Pölten emphasizes: "This project is a prime example of successful cooperation between several hospitals and a valuable initiative to combat hepatitis C in Austria." The University Hospital Vienna (AKH Wien), the hospitals Ottakring, Landstraße, Donaustadt, Floridsdorf and Favoriten as well as the Sisters of Mercy Vienna and in Lower Austria the University Hospital Sankt Pölten, the Regional Hospital Wiener Neustadt and the Regional Hospital Mistelbach participated in the project. With the successful cure of almost 400 patients, the project shows how important and effective targeted measures to eliminate hepatitis C can be.
