Hepatitis is largely unknown – yet it kills as many people as HIV/AIDS
Viral hepatitis affects hundreds of millions of people around the world every year, claiming close to 1.4m lives.
Around 500million people worldwide are living with either hepatitis B or C, which, left untreated, can lead to advanced liver scarring (cirrhosis), liver cancer and liver failure.
Hepatitis causes inflammation of the liver, and is the leading cause of liver cancer, globally. It is the world’s eighth biggest killer, having the same mortality rate as HIV/AIDS.
Despite these horrifying statistics from the World Health Organization (WHO), the viruses and the deadly diseases they can too often lead to, are largely unknown and/or ignored.
Healthcare professionals will tell you the UK is in the midst of a liver disease epidemic, and while the evils of alcohol are spelt out almost daily in the media, booze’s partner in liver-destroying crime, hepatitis, hardly gets a look in.
Yet it is largely symptomless, meaning it can develop to dangerous levels before the carrier is even aware of it, and has a nasty habit of seeking out the most marginalised.
People who inject drugs, and share needles, are most at risk from hepatitis C, and are also extremely unlikely to know about it. Estimates vary on how many of the country’s prisoners are carriers, but it could be as high as 31%.
If and when they are tested, the long, drawn-out treatment regimes are often punishing, with side effects including, but in no way limited to, depression, anxiety and a debilitating anal itch.
New drugs are promising to reduce both side effects and the treatment duration, but they are expensive.
Sofosbuvir is the first in this new generation of oral therapies to make it to market. It has been approved by the Scottish Medicines Consortium, and is available in England and Wales, to some, via a Government-supported Early Access Scheme.
NICE, though, is still considering its advice for the long term, and earlier this year asked manufacturer Gilead for more information on the drug’s “cost effectiveness”.
Studies have shown sofosbuvir “cures” hepatitis C in between 80 and 90% of people – nothing short of a miracle – but no matter how effective the medicine, people will not be treated if they don’t know they are infected.
Another barrier to treatment is the stigma attached to the virus: people would sometimes prefer to live with the consequences than tell their boss they need to take time off for hep C treatment.
As with most social stigmas, it is born of ignorance, of the causes and consequences of hepatitis in all its forms.
Enter #WorldHepatitisDay. Led by World Hepatitis Alliance and endorsed by WHO the global awareness day, held last week (28 July) generated news articles and got people talking about the “silent killer”.
Hepatitis C in the UK
Public Health England (PHE) marked #WorldHepatitisDay by publishing the 2014 Hepatitis C in the UK report.
It said around 214,000 people across the country were chronically infected, and a large proportion will go on to develop hepatitis C-related cirrhosis or cancer.
The most common way to contract hepatitis C is through sharing needles, but it can also be spread by snorting drugs, or picked up from unsterilised tattoo or piercing equipment.
Oyster interviewed PHE hepatitis C expert Dr Helen Harris for the BASL Clinical Community, and she said much of the disease we see today is the consequence of infections that occurred many years, even decades, ago.
“Because of on-going transmission, the asymptomatic nature of the infection and its long natural history, there is often a considerable time lag between infection and diagnosis of serious HCV-related disease,” she said.
Her solution is more awareness, more testing and more treatment. Prisons in England and Wales have recently started a screening programme that works on an opt-out basis, for example.
Testing at needle exchanges and GP surgeries is also starting to become the norm, though there is a long way to go.
“People will not remain ‘hard-to-reach’ if services become easy to access,” said Dr Harris.
Focus on quality care
NICE used #WorldHepatitisDay to publish Quality Standards on hepatitis B. They outline the levels of care the estimated 325,000 people in the UK with the infection should receive.
Hepatitis B is a blood-borne virus that is usually spread vertically ¬— i.e, from mother to child — though it is also transmitted sexually and by sharing needles.
The UK is home to thousands of people born in countries where the virus is epidemic, including Saharan Africa and East Asia, where between five and 10% of the adult population is chronically infected.
If awareness of hepatitis C is low, then it is at rock bottom when it comes to hepatitis B.
The UK is one of just a handful of countries that doesn’t run a universal vaccination programme, though pregnant women are screened for the virus and their babies vaccinated, if needed, shortly after birth.
Hepatitis A and E tend to be self-limiting, and are more prevalent outside of the UK, though an increasingly mobile global population means an increasingly mobile virus.
Awareness, then, is key – because treatments can only work if people get treated.
World Hepatitis Day is one of just four disease-specific global awareness days, along with TB, malaria and AIDS, because it poses as much danger to the world’s population as TB, malaria and AIDS.
By Amanda Barrell
Published on: August 6, 2014