Calls for national strategy on Hepatitis C

Hepatitis C (HCV) is a blood-borne virus that predominantly infects the cells of the liver. If left untreated, the virus can cause cirrhosis, liver cancer and death. According to figures from the World Health Organization, more than 350, 000 people die from HCV-related liver diseases every year.1 Recently, there have been some exciting breakthroughs reported,2 in relation to new antiviral drugs, which may be more effective and better tolerated than existing therapies, while early data have shown encouraging results for a potential HCV vaccine.3-5 Hope that the infection can be eradicated in the future is growing, but significant challenges need to be addressed. In the field of hepatology, high profile figures have warned that the UK is lagging behind the rest of Europe in the detection and treatment of HCV. In Parliament, David Amess MP called on the Government to publish its delayed National Liver Disease Strategy. Mr Amess, chair of the All-Party Parliamentary Group on Hepatology, said: “The Government needs to publish a robust liver strategy soon… Deaths from liver disease caused by HCV are increasing rapidly, even though it is a preventable and usually curable virus.” Speaking after the debate, Charles Gore, chief executive of the Hepatitis C Trust and president of the World Hepatitis Alliance, said: “David Amess MP has raised a vital but often forgotten issue. It is a scandal that so many people are dying from HCV when it is preventable and treatable. “At the moment, people are going to their doctors when the disease has progressed too far. The national liver strategy must focus on the prevention, diagnosis and treatment of HCV so people living with the virus can be diagnosed, potentially saving thousands of lives.”

The future of HCV infection in the UK

Issues raised during the debate were further addressed by a symposium, hosted by the British Association for the Study of the Liver (BASL), at the recent Digestive Disorders Federation (DDF) conference, Liverpool. Speaking at the conference, Professor William Rosenberg, Peter Scheuer chair of hepatology at University College London (UCL) and clinical lead for viral hepatitis at UCL Hospital and The Royal Free Hospital, commented that Health Protection Agency figures on HCV infection have underestimated the severity of the burden of disease. Prof. Rosenberg commented: “There are some common myths about HCV infection, which are of concern – the first is the belief that new drugs will solve the problem in the next five years. Staff and trainees are being told they should be prepared to divert to other areas of hepatology, and that their jobs may be at risk, as HCV will no longer be a problem. This is not the case. Another misconception is that, because NICE has approved the use of protease inhibitors, the UK is at the forefront of Europe and is performing well – which is not true.” The HPA estimates that the UK figure for HCV infection is approximately 216,000 – a figure that Prof Rosenberg disputes: “The HPA estimates that around 50% of individuals have been diagnosed. We have undertaken work which suggests that the figure is lower and closer to 43%. The HPA goes on to postulate that 70% of patients who are diagnosed are appropriately referred. I would suggest that the number is significantly lower... We must do better – the emphasis needs to be on detection as well as treatment.” While questioning these of rates of infection, Prof Rosenberg pointed out that current figures are still alarming – they show an upswing in the trend for hospitalisation for end stage liver disease, increases in transplant registration, and increases in rates of death. “The HPA figures, which I believe are underestimated, suggest that, by 2020, there will be over 15,000 deaths attributed to HCV. We are facing a growing epidemic,” he commented. He cited a recent study by Sylvie Deuffic-Burban, examining disease patterns across Europe, which showed that the UK is lagging behind other European countries in terms of detection and treatment. “If there is no intervention, modelling shows that prevalence in the UK for cirrhosis of the liver and its complications will peak in 2033 – not in the next five years, as some suggest,” he commented, adding: “On a more optimistic note, modelling also predicts that there could a 200% cumulative reduction in deaths by 2033.” He explained that this reduction could only be delivered if the following was achieved: • An increase in detection rates from 43% to 75% (the rates achieved in other countries in Europe). • Immediate introduction of protease inhibitors. • Availability of interferon-free therapies with very high levels of efficacy by 2015, for all patients with all genotypes. Ultimately, these are optimistic predictions, Prof Rosenberg pointed out.