B LOOD - BORNE IN F ECT ION
Progress in the fight for Hepatitis C elimination
The momentum gained in tackling Hepatitis C, before COVID-19, should not – and need not – be lost, says Professor Steve Ryder. He provides an insight into the latest developments in the fight to eliminate Hepatitis C and issues a call to action.
In April 2019, NHS England struck a deal with leading pharmaceutical companies to eliminate hepatitis C (HCV), an unprecedented move which hailed the start of a national HCV elimination programme.1 It involved those companies, who have developed ground-breaking direct acting antiviral (DAA) medicines, becoming directly involved in various projects that collectively formed the effort to eliminate a virus that, at the beginning of my career as a hepatologist, didn’t even have a name.
Hepatitis C is a blood-borne virus affecting
the liver. People can develop serious and long- term consequences of the liver, sometimes leading to their death if the virus is not treated. Around 89,000 people2
in England have
chronic hepatitis C (HCV) and about 143,0003 are affected by chronic HCV in the UK.
Progress so far
Over the last few years, even before the positive steps taken by NHS England, much progress had been made in reducing HCV among the population. In May 2016, The World Health Organization approved the first “Global Health Sector Strategy on Viral Hepatitis, 2016-2021”, where targets were set to eliminate HCV as a public health problem. The UK adopted the WHO’s goal of reducing new HCV infections by 90% and cut deaths by 65% by 2030.4
In January
2018, NHS England decided to go further in deciding to eliminate the viral hepatitis by 2025 in England.5
NHS England then developed the HCV elimination programme, now fully operational in England. It is a prime example of seizing an opportunity and not being afraid to take innovative steps to solve a public health issue – something that we have seen over the course of the past few months with the response to COVID-19. This is all truly game-changing. However, identification and long-term involvement of people with HCV in their care pathway remain challenging.
The DAAs that had been developed to treat the virus are straightforward oral treatments, easy to take over the course of a few weeks, and they cure the virus for the majority of patients. They also cause few side effects, which is a huge advantage over its predecessor treatment of intravenous interferon. This is especially important given the high proportion of chronic HCV patients who are current or former intravenous drug users. This is a key factor in the hepatitis C challenge. HCV heavily affects people from underrepresented and marginalised groups in our society. It is estimated that 90% of people affected by the virus in the UK are people who inject or used to inject drugs.6
Other groups
particularly at risk of infection are people in prisons, homeless and minority groups such as immigrants of South Asian or Eastern European origin. These groups represent a further challenge to address as they can be harder to identify, need greater support to access healthcare services and ultimately support to receive the whole treatment.
36 l
WWW.CLINICALSERVICESJOURNAL.COM
Latest statistics on HCV The soon-to-be-defunct Public Health England (PHE) publishes annual reports on the epidemiology of HCV across England and the UK. The latest UK report from PHE – published in in 2019 – shows a 20% reduction in numbers of people living with chronic HCV since 2015. PHE is confident that these figures show that it has met WHO targets for 2020. Furthermore, a fall in the number of deaths from HCV of 19% UK- wide3
and 20% in England,2 between 2015
and 2018, means that the WHO target to reduce HCV-related mortality by 10% by 2020 has been exceeded three years early, doubling the 2020 target by 2018. Given that the elimination effort is being driven ahead in England specifically, this looks very positive for meeting the ambitious targets that NHS England has set. However, there are challenges, and not just from the current coronavirus pandemic. These successes in driving down HCV infection are at risk of being overshadowed
FEBRUARY 2021
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72
