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1 August 2014

Next update: 1 August 2014

Last updated 1 August 2014, Vol. 8, No 30 (xxx PDF).

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Hepatitis C in the UK annual report

Across the UK more than 214,000 individuals (160,000 in England) are thought to be chronically infected with hepatitis C, many of whom are unaware of their infection. Morbidity and mortality from HCV-related liver disease continue to rise: UK hospital admissions for hepatitis C-related end stage liver disease and liver cancer have increased year-on-year for the past 16 years: from 608 in 1998 to 2,390 in 2012, while deaths rose from 98 in 1996 to 428 in 2012. UK registrations for liver transplants where post-hepatitis C cirrhosis was an indication for transplant have quadrupled from 45 in 1996 to 188 in 2013.

These are among the conclusions of the annual hepatitis C report published by Public Health England on World Hepatitis Day on Monday 28 July [1,2].

The report is the ninth for England, and the sixth also to present consolidated data for the UK as a whole. The main chapters describe (with data broken down between England and the devolved administrations): the scale of the UK problem: prevention activity in relation to people who inject drugs; diagnosis, testing and awareness of infection; and treatment and care. UK data on testing and diagnosis are presented for particular groups such as people who inject drugs (PWID); people in prisons; black and ethnic minority ethnic populations; blood donors.

M onitoring testing and diagnosis allows assessment of the impact of awareness-raising initiatives and prevention activity at a population level. Laboratory-confirmed new diagnoses of hepatitis C infection (HCV) reported in England rose to 11,051 cases in 2013, up by more than one third from the 7,892 cases reported in 2010 when statutory notification by diagnostic laboratories was first introduced.  London accounted for 28 per cent of all cases reported in England in 2013, more than treble at 3083 the 967 reported in London in 2010.

Although antiviral therapies exist and are approved for use in the UK that will clear the virus in most cases, only 28,000 patients in England were treated between 2006 and 2011: equivalent to three per cent per year of those who could have benefited.

Despite new and improved treatments expected to become available, the report questions whether a continued rise in HCV-related disease in England can be averted. Various scenarios are presented, based on statistical modelling, to quantify the impact of different levels of intervention. If only the current low level of treatment is maintained, the report concludes that the number of individuals living with HCV-related cirrhosis or liver cancer in England (currently almost 11,000) will continue to rise to over 13,000 in 2025. However, if rapid scale-up to complete coverage and more effective treatments were implemented, this number could be halved.

Minimising transmission of HCV among PWIDs (including those injecting new psychoactive substances or image and performance-enhancing drugs) is a key public health recommendation of the hepatitis C report. PWIDs are the main at-risk group for hepatitis C infection associated with sharing equipment for injecting drugs. Levels of infection in this group remained high in 2013, with around half of those surveyed in England being infected. 

A recent PHE initiative of significance for HCV control has been a National Partnership Agreement between PHE, NHS England and the National Offender Management Service to introduce a universal offer of blood-borne virus testing, including hepatitis C, for prison inmates, many of whom have hepatitis C.

References

1. PHE, HP Scotland PH Wales, HSC (Northern Ireland), July 2014. Hepatitis C in the UK: 2014 report.

2. Hepatitis C annual report: progress made, but much more to do, PHE press release, 28 July 2014.

3. Unlinked anonymous HIV and viral hepatitis monitoring among PWID: 2014 report, HPR 8(29).