Today I would like to share with you a case of hepatitis.
The patient was a woman, called Xiaojie (not her real name), 32 years old.
More than 10 years ago, that is, in 2007, when she went to college, Xiao Jie's life was hit hard.
Originally the college entrance examination results were good, to a city I liked, a university I liked, and a major I liked, but I didn't expect that I had an accidental blood donation and found out that I had hepatitis C.
Chronic hepatitis C.
Medical student, found out a terminal illness, it is really slippery, she smiled bitterly.
She had heard of hepatitis, she had heard of hepatitis B, but she hadn't heard much about hepatitis C before. The doctor told her that hepatitis C is as terrible as hepatitis B, even more terrible than hepatitis B, because most hepatitis C patients have no obvious symptoms, if there is no active physical examination, it is difficult to find hepatitis C, and by the time it is found, it has cirrhosis or liver cancer.
She was stunned when she heard this, and she could not relax for a long time. As a patient, at that time, the understanding of hepatitis, hepatitis C, etc. was still quite shallow. Later, after reading books and literature hard, I learned that there was no good way to treat hepatitis C at that time.
But don't be afraid, not all hepatitis C patients will develop cirrhosis and liver cancer. The doctor comforted her.
How can you not be afraid, at that time, hepatitis B has been well publicized, which makes people feel frightened. But since hepatitis C is also so terrible, why not see propaganda. She began to complain, and the doctor said that hepatitis C, like hepatitis B, is a blood-borne and sexually transmitted disease, and most patients are transfused.
She recalled that when she was a child, she had indeed lost blood once.
That would explain.
Hepatitis C virus was also discovered in the late 80s and early 90s, and for a long time it was impossible to find it in the blood, so when the blood samples of blood donors were screened, they were not screened for hepatitis C virus at all (screening blood donors for hepatitis C virus was only started in 1993), so that a hepatitis C patient was very likely to donate blood, and then his blood sample caused countless infections.
Ponder the horror.
Fortunately, researchers later found a means to detect and isolate the hepatitis C virus, which further standardized the blood sample testing of blood donors, which is why when she went to donate blood herself, she was found to have hepatitis C.
Is there really no way to cure it? She asked the doctor this question countless times. She couldn't accept that she was terminally ill.
An incurable disease, and as the days go by, it may also be cirrhosis of the liver, liver cancer, this is not a terminal illness what?
The doctor comforted her, it is not so terrible, chronic hepatitis C lasts for 20 years, the incidence of cirrhosis is about 5%, the incidence of cirrhosis and liver cancer is not too high, and although there is no cure, it can still be tried.
At that time, the antiviral regimen was long-acting interferon + ribavirin.
Around 2007, there are only a few antiviral drugs that can be used, and the effect is very small, ribavirin is a very old antiviral drug, using it to fight the virus, it is helpless, with an old and weak soldier is better than no soldiers available, probably this is the truth.
And interferons? Is it directly antiviral? No. Although interferon is a broad-spectrum antiviral drug, and it does not directly kill or inhibit the virus, but mainly through the cell surface receptor action to make the cell produce antiviral proteins, in other words, interferon does not stain its own hands, is to borrow a knife to kill (borrow a knife to kill the virus).
What about the cost?
At that time, long-acting interferon was still a rare drug, the price was very expensive, tens of thousands of starts, and a course of treatment was almost 100,000 or so. 100,000 yuan is simply astronomical for a college student from a poor family.
Xiao Jie was already trembling, as if she saw that she was about to usher in the tragedy of life.
Is such an expensive treatment effective? Is there a guarantee of cure? Xiao Jie asked a question that many patients would ask.
The doctor shook his head, saying that the hepatitis C virus is very cunning, easy to mutate, interferon + ribavirin, although the standard treatment, but the effect is not too ideal, the cure rate is about 30%-40%, less than half. Moreover, the side effects of interferon are also relatively large, which may cause a decrease in white blood cell counts, hair loss and so on.
The doctor's words hit Xiao Jie hard.
A disease that can affect life requires extremely expensive treatment and, more importantly, the success rate is still so low. Whether to treat or not, whether to treat, Xiao Jie struggled for several days.
She couldn't talk to her parents. The family also had two younger brothers, one was in junior high school and the other was in high school, the family's economy was not good, his father was laid off, his mother did some odd jobs, and it was difficult to maintain his livelihood. Even if you borrow all your friends and relatives, you can't get the 100,000 yuan.
Xiao Jie was in a particularly bad state during that time, often having nightmares, dreaming that she had liver failure and died.
But then she figured it out too. Doctors have said that this hepatitis C is a chronic disease, it will not die for a while and a half, and it may take more than ten years to become serious. If that's the case, why don't I make money to buy medicine myself?
Thinking of this, Xiao Jie's heart was a little better. Just pray to God, don't let your illness progress too fast.
In order to learn more about hepatitis C, Xiao Jie began to try to read relevant books, under the guidance of netizens, also looked up the chronic hepatitis C guide to learn at that time (2008 version), the guide at that time did say that hepatitis C can not be cured, and the slightly effective is long-acting interferon + ribavirin (PR program).
But the price is indeed expensive, and Xiao Jie had to give up.
She began to look for various opportunities to work part-time, earn living expenses, and save medical expenses.
During this period, she absolutely does not touch alcohol, when the classmates gather, everyone will drink beer, Xiaojie does not stick to the wine, and does not dare to stay up late and exercise well. Xiao Jie told me that she was also grateful to hepatitis C for giving her a chance to be a more self-disciplined self, hehe, and she could only comfort herself so much.
In 2012, Xiao Jie fell in love.
After the fire was in full swing, he explained the situation with his boyfriend, and the boyfriend learned that Xiaojie had hepatitis C, and he did not dislike it, everyone was a medical student, and they were about to graduate, and they somewhat understood.
The two made an appointment, worked hard together, and earned money to buy medicine.
In 2013, the first year of work, Xiao Jie, in addition to sending some money back to her family, basically did not spend much else, and saved it. The boyfriend also works very hard.
Soon, the two men scraped together tens of thousands of dollars.
Found a doctor.
At this time, a doctor was changed, but the doctor still said that, long-acting interferon (polyethylene glycol interferon) + ribavirin This program to treat hepatitis C is the current first choice, once a week injection, treatment for 48 weeks (almost 1 year), a interferon was almost 1200 yuan at the time, and it may only be 30% effective.
The doctor thought that the effective rate was only 30%, which was even lower than Xiao Jie knew at that time.
A little disappointed, but it's better than doing nothing.
Jie and her boyfriend decided to start antiviral therapy.
After a few months of use, during the review of the indicators, the effect was not very good, and there was an embarrassing side effect, Xiao Jie's hair fell off one by one. The doctor said that this is normal, and interferon has this side effect.
There are no girls who don't love beauty. Xiao Jie couldn't stand it, when the medication was about 32 weeks, the effect was still not good, coupled with the severe loss of hair, Xiao Jie painfully ended the treatment.
That year was 2014, and Xiao Jie felt desperate for her illness, unprecedented despair. The first choice of treatment is interferon + ribavirin, but it is ineffective, and it cost money, hair fell out, and Xiao Jie was tortured and physically exhausted. If it wasn't for the encouragement of that friend all the way, she might have wanted to find a bridge to jump off.
Later, she learned that she had depression and anxiety thoughts at that time, which may be a side effect of interferon, which is difficult to say.
Fortunately, the hardest time has passed.
After stopping the treatment, the body gradually improved, and the hair that had fallen out gradually grew back. If you don't deliberately think about the fact that you have hepatitis C, Xiao Jie looks no different from ordinary people.
But hepatitis C is an infectious disease after all, afraid of infection to the boyfriend (sexual transmission), afraid of infection to future children, afraid of this and afraid of that, Xiaojie can not really ignore her own hepatitis C.
That devil-like hepatitis C, pestering her, couldn't get rid of it.
One day around 2016, Xiao Jie's boyfriend excitedly told Xiao Jie an exciting news.
The United States has developed a new drug, called direct antiviral drugs (DAA), it is said that after 3 months of treatment, there is a 95% probability of curing hepatitis C, yes, it is a cure for hepatitis C.
No need for injections, no hair loss, the cure rate is super high, the treatment course is short, this is simply a life-saving medicine! Xiao Jie was overjoyed.
But after a deeper understanding, the two fell into a trance.
Sofobuvir (the first DAA drug, developed and produced by Gilead) is a miracle drug, and many studies have shown that the cure rate after 12 weeks of treatment has reached more than 95%, but the price of this drug is also staggeringly high.
A course of treatment down, nearly 500,000, RMB.
And this drug has not yet been listed in China, if you want to buy it, you may get it in the United States, or go to Hong Kong. Not to mention where to buy it, let's say that the 500,000, the two people are really no rut, at that time the two people deposited tens of thousands of dollars, but also wanted to get married, everywhere are using money, simply can not make up hundreds of thousands of dollars.
Xiao Jie and her boyfriend's family are not rich, and even need both of them to subsidize the family. Who borrowed it, ask? Friends I know are not rich and noble people, and it is not easy to borrow money.
There is no way but to continue to work hard and try to save money.
One night, my boyfriend was crying.
Two young people, hugging each other and crying bitterly. The kind of despair that knows that there is a cure, but because the price is expensive, cannot be felt without personal experience.
There is no way out of the sky.
In 2017, Xiao Jie's boyfriend found out, in fact, the United States sofosbuvir in 2013 was approved for listing in the United States, the domestic has not been listed, and there is no domestic generic drug, the domestic hepatitis C guidelines (2015) also mentioned this direct antiviral drug (DAA), but because there is no drug into the country, can only drool, continue to use interferon + ribavirin antiviral program, look forward to the future one day in the domestic market life-saving drugs.
This is the case at home.
What about abroad?
Like India? Xiao Jie's boyfriend learned on the Internet that there are generic drugs in India, India's generic drugs are high, sofosbuvir came out, India immediately had generic drugs, and it is said that the efficacy is also very good, comparable to the original research drugs, and the price is only one-tenth of the original research drugs, or even low. Many people have bought generic drugs in India through various channels and obtained a cure for hepatitis C.
Xiao Jie's boyfriend saw the life-saving straw.
Xiao Jie herself was also excited.
If there is really a generic drug, the price is so much cheaper, and the efficacy is so good, it is really an eye-opening.
Xiao Jie couldn't wait to find a doctor and put forward the idea of buying generic drugs. The doctor also told him that the hospital did not have goods, but he could contact the purchasing agent, and the purchase could be purchased on behalf of him, and the price of a course of treatment was more than 20,000 yuan.
This price is relatively cheap to the floor compared to the original research drug. Just when Xiao Jie was ready to pay for it, a friend said that she could buy medicine directly from India, and a course of treatment was about 5,000 yuan.
Xiao Jie hesitated.
5000 yuan? The price is already too cheap to be negligible. Is this a real medicine?
Friends say that Indian generic drugs are famous and of good quality, and they don't have to make fake drugs.
After weighing, Xiao Jie decided to ask a friend to buy on behalf of her, 5,000 yuan, and bought a generic drug with a 12-week course.
It also took a long time for Xiaojie to get so many connections between generic drugs. In 2013, gilead developed and produced the first generation of sofosbuvir, known as the Ji generation, the effect is very good, the cure rate is very high, but not all hepatitis C genotypes are effective (hepatitis C has a total of 6 genotypes). In 2014, Gilead Company did not stop, developed and produced the second generation of sofosbuvir, is a compound preparation, the effect is better, the history is called the second generation of Ji.
After 2 years, in 2016, Gilead developed and produced the third generation of sofosbuvir, which is also a compound preparation, a tablet containing 400 mg of sofosbuvir, 100 mg of vespatavir, both of which are powerful antiviral drugs, and now combined, the effect is better, and it can be effective for all hepatitis C types, with an effect of more than 98%. The history is called Ji III.
Ji Sanshiro is already a fighter in the magic medicine. Americans' original research drugs are ridiculously expensive, because people have high costs in early research and development, so the price is very high in the later stage, which is understandable. But generic drugs in India are ridiculously cheap, with a 12-week course of drugs costing only $5,000.
Xiao Jie what they want to buy is this Ji Sandai, produced by a company in India.
After many twists and turns, Xiao Jie got the magic medicine sent from India. (I am not a medicine god This movie, only released in 2018)
Is it real medicine or fake medicine? Xiao Jie and her boyfriend actually have no bottom in their hearts.
But because the price of drugs is very cheap, compared with the price of hundreds of thousands of drugs, it is simply negligible. Eat it, in case it works. At best, it just doesn't work, it can't be poison. And the network says that the side effects of the third generation of Ji are very small and very slight.
Nothing could make Xiao Jie more excited than curing hepatitis C.
She waited for almost 10 years for this day.
Eat it.
The doctor said to use one pill a day for 12 weeks and could not be stopped. At least 97% of people can be cured.
Xiao Jie ate for 2 weeks and did not feel any changes in her body. Trembling, he went to the hospital and asked for a review.
When the results came out, the doctor was stunned, and Xiao Jie and her boyfriend were also stunned, and then cried with joy.
Laboratory tests showed that liver function was normal and the hepatitis C virus content could not be measured.
Replication of the hepatitis C virus is suppressed and liver inflammation is restored.
That's just 2 weeks of eating. This medicine is convenient to eat, and it will not lose her hair, and Xiao Jie is almost crying.
The doctor said that although it is effective, do not stop, continue to eat, eat for 12 weeks, eat these three boxes of medicines, and then evaluate.
3 months passed quickly, 84 days to be precise. Each box of medicines has 28 tablets, a total of 3 boxes, exactly 84 days of eating.
After 84 days passed, Xiao Jie went to the hospital for testing, and still did not detect the hepatitis C virus, and the hepatitis C RNA could not be detected.
It was a big surprise.
After another 3 months, the retest was repeated, and the hepatitis C RNA was still undetectable.
The doctor made up his mind and was cured. Yes, although the hepatitis C virus is highly variable, if there is no sign of recurrence within 3 months of testing, it means that it is cured, and the probability of recurrence in the future is almost zero.
Xiao Jie squatted on the ground and cried for a long time.
She waited for this sentence, waited for this day, and waited for 10 years.
After returning to Her senses, Xiao Jie thought about many questions.
Why does our country not have such a good drug, why should we go to India to buy it?
This is a very complicated problem, the doctor said, the domestic drug listing needs approval, the domestic approval procedure is more reviewed, not that the United States has us will have it immediately, in addition, even if we also have this drug, it can only be the original drug in the United States, we can not imitate, because the patent law stipulates that our pharmaceutical factory can not be imitated, only after the patent period can begin to imitate, the patent period is generally 20 years.
So why are there generic drugs in India?
This is more complicated. This involves all aspects of economic interests, humanitarian and other issues, India is huge, but it is still a relatively poor country, the Indian government ignores the patent law, allows its own pharmaceutical factories to imitate any advanced drugs, and their level of imitation is not a little higher than ours, and even some generic drugs are authorized by the original pharmaceutical factory, that is to say, they will provide formulas to make India imitate, so the effect of Indian generic drugs is also quite good, and even some people say that they can be compared with the original drugs, more importantly, The price of generic drugs in India is really much lower.
Therefore, India's generic drugs have become a life-saving drug for many desperate patients.
Now our country also allows everyone to go to India to buy medicine for treatment, as long as it is not for the purpose of profit, but for their own treatment, they can buy it without restriction. Xiao Jie said to me.
In 2018, the original American research drug Ji III (sofobuvir 400mg / wipatamivir 100mg compound preparation) was finally listed in our country. After the listing, it took a very interesting trade name:
Protonsha.
Good guys, clear-eyed people know what this trade name means at a glance, propiona, the harmonic sound is c tong kill, hepatitis C tong tong kill. In fact, it is true that The third generation is a pan-genotype of drug, and it works regardless of the patient's gene type of hepatitis C (there are 6 genotypes in total). In the past, when eating the first generation of Ji and the second generation of Ji, hepatitis C patients also had to do genetic tests to see if the symbols did not meet the indications for medication. Now that the genetic test is exempt, I will take the medicine and eat it directly, no matter which genotype, it will be effective.
Protonsha, worthy of the name. As long as it goes through 12 weeks of regular treatment, the vast majority of hepatitis C patients can be cured, it is cured, not controlled.
Unfortunately, the price of proponsa, which was listed in 2018, is still outrageous. The price of each box is still about 23,000 yuan, and a course of treatment requires 3 boxes of drugs, adding up to almost 70,000 yuan. 70,000 yuan, for many working family patients, is still an unbearable huge medical expenses. Although the drug is fragrant, the price is also fragrant.
At that time, Xiao Jie did not care much about the situation of Proponsa, because Xiao Jie's hepatitis C had been cured by Ji San in India. But as a former hepatitis C patient, she still pays attention to the relevant news.
In 2019, after negotiations between the National Medical Insurance Bureau and pharmaceutical companies, Proponsa entered the medical insurance, the price was compressed by 85%, plummeting to about 4,000 yuan / box, then a course of treatment cost 12,000 yuan, which is many times better than before.
An expensive original research drug, why is it willing to reduce its own price to enter medical insurance? Pharmaceutical companies are not philanthropists, and of course, what pharmaceutical companies do helps patients. But behind the accounting of economic interests, just imagine, in the past ten years, our country will have about 200,000 new hepatitis C cases every year, if an original drug does not bargain, it is not many hepatitis C patients can afford to use his drug. Cut prices, and enter health insurance, then you can make small profits and sell more. No matter what the pharmaceutical company thinks, the price has been reduced anyway, which is a good thing for the people.
Is this the end of the matter, and not yet.
The country is huge, the economic development of various places is uneven, and the medical insurance policy is not the same. Even if protonsha has entered the medical insurance directory, many patients in many places still express headaches, because the hospital can not buy the protonsha that enters the medical insurance, and can only buy it in the outside pharmacy, although the price is cheaper than before, but it is also about 12,000 yuan (different places).
This price is higher than buying generic drugs in India. A box of medicines imitated by a pharmaceutical factory in India is more than 1,000, and the three boxes of drugs are almost 4,000 yuan, and the effect is leveraged. Therefore, many people will also choose to try all kinds of ways to buy generic drugs in India.
Of course, where the medical insurance policy is good, the treatment of hepatitis C with proponentsa, a course of treatment may not cost a dime, medical insurance is given to the bottom, such things also exist.
So Medicare still does a lot of good things, and people remember it. But there is certainly still a lot to be done.
Anyway, chronic hepatitis C patients, when you read this article, I believe you already have a basic understanding that hepatitis C can already be cured.
Hepatitis B and C are our most common viral hepatitis, two difficult brothers, there are the same and different. Hepatitis B is a DNA virus, there is a vaccine can be prevented, but there is no specific drug, can not be cured, is still controlled treatment. Hepatitis C is just the opposite, there are already special drugs that can cure it, but there is no vaccine, there is no way to prevent it.
In the past ten years, our National Center for Disease Control and Prevention data still shows that there are 200,000 new cases of hepatitis C every year, it is estimated that they were infected before, and now they have been discovered, and now there are fewer blood transfusions infecting hepatitis C, plus hepatitis C can be cured, and it is estimated that in the near future, hepatitis C will completely disappear.
As the infectious disease doctor said, there is no way to completely eliminate hepatitis C now, because many people have not found hepatitis C, once they go to the blood test will find hepatitis C, find one to clear one, after all, drugs like Ji Sandai are really fighters in the rooster. After entering the medical insurance, some places are completely free (including examination and treatment), some places medical insurance reimbursement after their own thousands of dollars, some places a course of treatment down to more than 10,000, which is much better than the previous hundreds of thousands of at every turn.
Hopefully, hepatitis B will one day too.
Thank you for XiaoJie's story and wish her all the best.