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.”
National estimates 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.
Prevention 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.
Nevertheless, the 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.
Expanding the 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.
“Beyond the 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 be collected.
- More up-to-date prevalence studies are needed. The results should inform decisions about the need for further targeted prevention campaigns.