The UK is making
progress in the prevention, diagnosis and treatment of hepatitis C virus (HCV),
a new report published by Public Health England (PHE) shows. Findings of Hepatitis C in the UK: 2013 Report show
that prevention initiatives targeted at high-risk groups are making headway and
that laboratory confirmed diagnoses of HCV increased by a third in England
between 2010 and 2012. However, much remains to be done. Only 3% of people with HCV in England receive potentially curative treatment in any
one year and many individuals remain unaware that they have the virus.
“It is…vital to
raise awareness about this condition so that more individuals are diagnosed and
treated,” said Dr Helen Harris, a specialist in hepatitis at PHE. “Numbers of
hepatitis C-related end-stage liver disease and liver cancer patients could be
substantially reduced by increasing access to treatment.”
now show that an estimated 215,000 people are living with chronic HCV infection
across the UK. There were 10,873 new diagnoses in England in 2012, an increase
of one third since 2010.
People who inject drugs remain the group most affected by this bloodborne virus. Anonymous
testing programmes in England suggest that close to half of people who inject
drugs have HCV, a prevalence which has remained largely unchanged
for several years. But progress appears to being made in diagnosing the
infection. Some 52% of injecting drug users participating in the 2012 anonymous
testing survey were aware of their infection status – an increase from 42% in
2002. In Scotland, the number of people testing for HCV has more than doubled from 18,000
in 1998 to 41,000 in 2012. Of the estimated 37,600 people living in Scotland
with chronic HCV infection, over half are thought to be diagnosed.
initiatives appear to be achieving progress among injecting drug users. The
number of individuals reporting sharing injecting equipment remains on a
downward trajectory and harm reduction programmes are expanding. The latest
data show that 83% of people who inject drugs in England accessed the safe
injecting equipment provided via needle and syringe programmes.
authors of the report are far from complacent, and write “there remains a need
to increase the amount of equipment distributed, with better targeting of this
provision and education on appropriate needle and syringe cleaning techniques.”
Uptake of HCV
testing in primary care is increasing, and the report draws attention to awareness
and testing initiatives targeted at individuals of East Asian origin where
prevalence of the infection is high.
The report also
highlights the ongoing epidemic of sexually transmitted HCV among HIV-positive
gay men. But there is some encouraging evidence that the rate of new infections
is slowing. Incidence has declined significantly over the past four years and
now stands at 2.2 per 1000 person-years.
HCV can be cured
with a course of antiviral treatment. Despite this, the proportion of patients
receiving HCV therapy remains low. In England, an estimated 27,500 individuals
received pegylated interferon-based treatment between 2006 and 2011. Only 3% of
patients each year are receiving treatment. In Scotland, approximately a
quarter of all patients with diagnosed HCV infection have been treated.
Other data in the
report showed the importance of prompt diagnosis and treatment. Hospital
admissions in England for HCV-related end-stage liver disease or liver cancer
increased from 574 in 1998 to 2266 in 2012. Deaths due to HCV-related disease
doubled over the same period from 115 in 1998 to 326 in 2012.
proportion of patients receiving therapy has the potential to significantly reduce
HCV-related morbidity and mortality. The authors highlight the results of an
epidemiological model showing that doubling the number of patients receiving
HCV therapy over the next ten years could avert approximately 6000 HCV-related
deaths due to end-stage liver disease or liver cancer over the next 30 years.
obvious benefits for the individual, there is also a growing body of evidence
to suggest that effective treatment has a contribution to make in reducing
transmission of the virus,” writes Dr Mary Ramsay, Head of Immunisation,
Hepatitis and Blood Safety at PHE.
While the report
shows that clear progress is being made, it is equally apparent that the UK
needs to further scale up efforts to prevent, diagnose and treat HCV.
“It’s good news
that more people than ever are being diagnosed,” said Dr Paul Crosford, of PHE.
“However there is much more that can and should be done to prevent more deaths
and serious illness.”
The authors make a
number of recommendations for the improvement of the UK’s response to HCV:
- Services for people who inject
drugs need to be sustained and expanded.
- Testing rates need to increase
in high-risk groups.
- Primary care providers should
be encouraged to receive HCV awareness training.
- Consideration should be given
to expanding HCV treatment services into non-traditional settings such as drug treatment
centres, prisons and primary care.
- Resistance to new direct-acting
anti-HCV drugs needs to be carefully monitored.
- Reliable data on the numbers of
patients receiving HCV therapy, including treatment with newer drugs, needs to
- More up-to-date prevalence
studies are needed. The results should inform decisions about the need for
further targeted prevention campaigns.