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HEPATITIS C VIRUS Chronic Hepatitis C (CHC) is an infection of the liver caused by a blood borne virus, hepatitis C (HCV). It was formally identified in 1989, previously being known as non-A, non-B hepatitis. HCV is ten times more infectious than HIV and the prevalence of infection worldwide is 20 times more common than HIV. At least 170 million people throughout the world have chronic HCV infection but only a small proportion of them are aware of their infection. HCV becomes persistent or chronic in 75-85% of individuals exposed to the virus, although many people do not experience any symptoms of this ‘silent epidemic’ for up to 30 years after infection. Those who are symptomatic may report mild to severe fatigue, nausea, abdominal pain, itching, poor concentration, sweats, joint pains and other non-specific complaints. Late on in the course of the disease once cirrhosis has developed patients may develop jaundice, abdominal swelling and excessive bruising or bleeding. Most people are unaware of becoming infected. Primary transmission routes are through injection drug use and exposure to contaminated blood products. Since routine screening of donated blood was introduced in the UK in 1991, spread via this method is now rare in the UK. However any procedure that can result in blood to blood contact can result in transmission of HCV. Other routes of infection include tattooing, body piercing, needle stick injuries, mother-to-child transmission during childbirth, and, rarely, high risk sexual behaviour. HCV is a major cause of chronic liver disease worldwide. Chronic HCV infection may induce progressive liver damage through fibrosis and, in 30% of cases, cirrhosis leading to death through liver cancer or liver failure. There is currently no vaccine against hepatitis C. Effective treatment, however, is available with a combination of pegylated interferon and Ribavirin. With early detection and treatment, 50-80% of patients could be stabilised or cured. The UK has a notably lower treatment rate compared with other European countries, with only 1-2% of infected people in the UK receiving NICE recommended combination therapy 1. For patients with advanced liver disease, transplantation is the only option and HCV is now the most common indication for transplantation in Europe and the USA. The high cost of treatment and liver transplants places a substantial burden on national healthcare systems. However, as the disease progresses to decompensated cirrhosis causing severe illness, frequent hospitalisation and requiring liver transplantation or resulting in death, the costs rise significantly. This underlines the need for early detection and preventative treatment, particularly with the projected explosion of severe liver disease in the next 10 to 20 years. 1. National Institute for Health and Clinical Excellence. Interferon alfa (pegylated and non-pegylated) and ribavirin for the treatment of chronic hepatitis C – Guidance. January 2004 Hepatitis C Trust www.hepcuk.info |
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