HEP C
WITH THE SCOTTISH GOVERNMENT COMMITTED TO THE ELIMINATION OF HEPATITIS C AS A PUBLIC HEALTH CONCERN IN SCOTLAND, ANDREW RADLEY, CONSULTANT IN PUBLIC HEALTH PHARMACY AT TAYSIDE HEALTH BOARD, CONSIDERS HOW COMMUNITY PHARMACISTS WILL HAVE A LARGE PART TO PLAY IN DELIVERING THIS HEALTH GAIN FOR THE PEOPLE OF SCOTLAND.
HEPATITIS C: CAN
hepatitis C every day. Hepatitis C is a blood-borne virus infection causing chronic inflammation of the liver. Approximately 80 per cent of acute hepatitis C infections are without symptoms and 55-85 per cent of all HCV infections become chronic: most people do not clear the infection themselves. Therefore, it is likely that many infected individuals are unaware of their positive status because of the often silent nature of the infection. A person can be infected with Hepatitis C for many years without having any symptoms. However, leaving the infection untreated can have serious consequences for the person’s health.
COMMUNITY PHARMACY PROVIDE THE CURE? M
ost community pharmacists in Scotland will meet a person infected with
Hepatitis C is not just one virus; there are a number of different strains. These strains have been grouped into six categories known as genotypes 1 to 6. Specific genotypes are associated with different areas of the world. The commonest genotypes for Scotland are genotype 1, which infects around 46 per cent of sufferers and genotype 3, which infects around 48 per cent¹.
Hepatitis C was only identified in 1989 and scientists continue to discover more about the virus and how it functions as a human infective agent.
8 - SCOTTISH PHARMACIST
In Scotland, around 50 000 people are thought to have been infected with hepatitis C with an estimated 38,000 now suffering from a chronic infection. This means that around 0.8 per cent of the Scottish population are chronically infected with this virus². The greatest risk of acquiring this infection in the United Kingdom is through injecting drug use. The largest single infected group are those on opiate substitution therapy (OST) (usually methadone or buprenorphine). Research suggests
around 40 per cent of people receiving opiate substitution therapy have hepatitis C infection. Most of this patient group visit a community pharmacy frequently, with many coming into contact with a pharmacist every day of the working week.
Patient outcomes from this infection vary. About 25 per cent of people clear the infection spontaneously; however the remainder become chronically infected and risk the development of cirrhosis and hepatocellular carcinoma. Since people infected with hepatitis C may be unaware of their infection and may show no symptoms, they can present with incurable, end-stage disease. A recent Public Health England report highlighted that less than three per cent of those known to be infected with HCV are being treated and less than half of those infected are known 3
.
Hepatitis C is a major cause of liver disease. The world-wide burden of hepatitis C virus infection has been estimated at between 130-150 million infections, with the largest group being genotype 1. The increased morbidity, mortality and economic impact of the infection are of concern to both industrialised and developing countries. The Scottish Government’s policy intention for improving the health of people is set out in the Sexual Health and Blood borne Virus Framework 2016-2020. The Framework notes that more than 55 per cent of the estimated hepatitis C infected population in Scotland was diagnosed in 2013, compared with only 38 per cent in 2007. The number of people commenced on antiviral therapy for hepatitis C has increased significantly, from 470 in 2007/08 to 1,270 in 2014/15 4
.
Most pharmacists will be aware of the introduction of the new highly effective oral medicines to cure hepatitis C. The paradigm shift resulting from the introduction of new oral Directly Acting Antiviral drugs (DAAs) has changed the narrative, with a realisation that hepatitis C infection could be eradicated in people who inject drugs. With the emergence of the highly-effective new therapies, the Scottish Government has committed to the elimination of hepatitis C as a public health concern in Scotland. Community pharmacists will have a large part to play in delivering this health gain for the people of Scotland.
The new DAA drugs achieve high rates of sustained viral response (SVR) – a cure – in people who complete an eight-week or twelve-week course. Most of the recently introduced regimens achieve SVR rates in excess
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