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UK Government HCV Report: Increase In Hepatitis C Diagnoses For 2008, UK
13 Dec 2009
Health Protection Agency
1. 'Hepatitis C in the UK - 2009 Report' summarises current knowledge about hepatitis C and the action being taken to tackle the infection. To see a full copy of the report, visit:
HCV Transmission among HIV+ MSM
"Enhanced Surveillance of Newly Acquired Hepatitis C infection in men who have sex with men (SNAHC): HPA established an enhanced surveillance system in collaboration with the British HIV Association (BHIVA) and the British Association for Sexual Health and HIV (BASHH).....During the first 17 months, 105 newly acquired HCV cases were reported; 56 confirmed and 49 probable cases. The median age at diagnosis was 38 years (range 19-62) and the majority of MSM were UK born (63%), and of white ethnic origin (89%). The majority of MSM (96%) had already been diagnosed with HIV, with a median of four years between HIV and HCV diagnoses. The main reason for testing was raised liver function tests (LFTs) reported in 62% of cases.....A history of intravenous drug use was reported for only 17 (16%) cases, seven of whom injected within the last six months. Recreational drug use (non-injecting) during the last 12 months, however, was reported in 60% of cases, with a high proportion engaging in sex while under their influence. The majority of cases were among HIV positive MSM with high numbers of recent partners, a high rate of unprotected anal intercourse and a high rate of other recently diagnosed STIs. These high risk activities along with the higher HCV viral load29, the higher rate of HCV RNA in semen30, and the prolonged viral half-life31 in individuals with HIV infection, compared to HIV negative individuals, may account for the enhanced transmission observed among HIV positive MSM. Formal incidence estimates have not yet been undertaken, but the overall number of reports in 2008 was lower than the number expected from a pilot scheme conducted in 2006 and 20077, and provisional numbers suggest a further decline in 2009. This suggests that transmission may have stabilised in London and the South East. The inclusion of other geographical areas in SNAHC is being actively pursued."
Figures from the agency's yearly report on Hepatitis C for 2009 show that laboratory reporting of newly diagnosed hepatitis C infections in England increased in 2008 by 6% compared to 2007, with 8,196 new cases reported in 2008.
Hepatitis C is a viral infection which causes swelling or inflammation of the liver. It is transmitted when the blood of an infected person mixes with a recipient's blood, such as via injecting drug use and the sharing of needles. Because hepatitis C infection is predominantly asymptomatic in the early years, many individuals remain undiagnosed until the disease has progressed. If the infection is diagnosed in the early stages, treatment can be offered that can clear the infection in more than half of those treated. However, some infections remain undiagnosed until end-stage liver disease is reached, when a transplant becomes the only real option.
It is estimated that currently around 185,000 individuals in the UK are chronically infected with hepatitis C (142,000 in England & Wales, 39,000 in Scotland and 4,000 in Northern Ireland); these individuals are at risk of developing serious liver disease.
Predictions from the HPA indicate that the future burden of this disease on the health service will be substantial if awareness, diagnosis and treatment do not increase. This can already be seen in national mortality figures, hospital admissions and transplant data, which all show that hepatitis C related serious liver disease is continuing to increase year-on-year.
The increase in newly diagnosed cases may be attributable in part to the public information campaigns and the subsequent increase in awareness which has encouraged more people to come forward and get tested. Awareness of hepatitis C may be increasing in the general population, as well as in key risk groups.
Dr Helen Harris, a hepatitis C expert from the Health Protection Agency, said: "Too many people with hepatitis C are still undiagnosed. It is critical that awareness campaigns are sustained and enhanced if more people at risk of this infection are to be tested and treated.
"Liver disease is largely preventable and yet it continues to rise unlike other major causes of death in the UK such as cancer, heart disease and stroke. Tackling undiagnosed hepatitis C infections by increasing awareness and encouraging testing could have a major impact on the number of people suffering needlessly from liver disease in the future."
Recent campaigns to raise awareness of hepatitis C have included the 'Get tested, Get treated' campaign launched this year to target former injecting drug users together with a campaign targeting the South Asian community, who are at increased risk of infection and who may have acquired their infections via other routes. Other work on a national level to tackle hepatitis C and the other causes of liver disease has included creating the new position of National Clinical Director, who will lead on the development of a national liver strategy.
The work of the Health Protection Agency includes monitoring trends in hepatitis C at a national level and working with other agencies through a network of local leads to improve services for the prevention, diagnosis and treatment of hepatitis.
Currently, the greatest risk of contracting hepatitis in the UK is through sharing equipment for injecting drugs. Sharing injecting equipment, even on a one-off basis, or a long time ago (as many people remain asymptomatic for years), could place an individual at risk of hepatitis C.
Predicting the future burden
of infection in England

(from Jules: it looks to me they predict about 8% of HCV-infected will have cirrhosis by 2015.:


Hepatitis C in the UK: 2009 report
Health Protection Agency
Publication date: December 2009
Download full publication
Hepatitis C in the UK.2009 Report (PDF, 4.1 MB)
All primary care organisations in England and Wales should ensure that integrated pathways of care are available for patients with hepatitis C (ideally coordinated through a clinical network).
Strategic health authorities in England should take the lead in supporting local commissioners to ensure complete implementation of the hepatitis C Action Plan across all PCTs in their regions.
Commissioners and providers of services for injecting drug users in Wales and Northern Ireland need to review their programmes to ensure that a broad range of prevention services (in addition to needle and syringe exchange) is available. Primary care organisations in England should develop mechanisms for obtaining reliable data on the number of patients referred, seen and treated for hepatitis C.
Lead agencies in Northern Ireland, Scotland and Wales need to urgently initiate expanded public information campaigns to raise awareness of hepatitis C. Lead agencies in Wales and Northern Ireland should investigate the need for targeted public information campaigns to raise awareness of hepatitis C in individuals from the Indian sub-continent.
Commissioners and providers need to ensure that a high rate of testing in those attending specialist services for drug users is maintained. Lead agencies in all UK countries should ensure widespread access to testing for hepatitis C using alternative specimens (for example, oral fluid and dried blood spot).
Providers of prison health services should develop testing strategies and care pathways that allow equitable access to treatment services for offenders. Lead agencies in all countries should assess the impact of awareness campaigns, by monitoring testing outside of high risk group settings.
National and local agencies should make efforts to understand and improve the completeness of routine surveillance systems for hepatitis C.
All commissioners of HCV services should evaluate the coverage of HCV testing services in their area and ensure that laboratories have appropriate pathways for referring samples for confirmatory testing.
National surveillance centres should develop systems for assessing and monitoring the incidence of hepatitis C in key risk groups. This includes injecting drug users, and if appropriate, HIV positive MSMs.
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