chronic( ie long-term) infection. 6
Not all chronic infections develop the same way, with some people experiencing symptoms almost immediately and others displaying none for a decade or longer. The liver damage caused by the virus begins with fibrosis – the build-up of scar tissue – which can then go on to become cirrhosis, where the scarring has built up in the organ’ s tissues to the extent that it impairs its functioning.
Liver damage can lead to jaundice, the symptoms of which are a yellowing of the skin and eyes, and other people with chronic HCV will experience difficulty concentrating, poor memory and chronic fatigue, as well as joint pain – particularly in the hands and wrists – and sharp pains over the liver. People can also experience irritable bowel and bladder symptoms, although the Hepatitis C Trust points out that it is‘ still not clear whether these symptoms are related to hepatitis C infection or not’, as they could be caused – or at least worsened – by the stress associated with living with the infection.
In severe cases, hepatitis C can also lead to liver cancer. The exact links between HCV and liver cancer remain unclear, but it is thought that the virus creates the conditions for cancer to develop by causing a high turnover of liver cells, as well as possibly interfering with the mechanism that repairs damage to cell DNA.
WHAT’ S BEING DONE? MAJOR STRATEGY DEVELOPMENTS
Despite the huge public health threat posed by HCV, as well as the economic impact, the condition was until recently, in the words of the Hepatitis C Trust,‘ grossly under-prioritised’ by health services. That is no longer the case, however, and the most significant development in recent years is NHS England’ s strategy to eliminate the virus by 2025, five years earlier than the target set by WHO. 8
Announced at the start of 2018, the strategy could make England the‘ first country in the world’ to completely eliminate the virus, the NHS has said. 9 Working in partnership with the pharmaceutical industry, the strategy aims to identify more people living with the virus and provide best value in treatment. Deals already reached with the industry mean that England is one of the few European countries where the number of people receiving oral treatments is
A TOXIC MIX: HOW ALCOHOL AND DRUGS INTERACT WITH HCV
ALCOHOL – along with recreational drugs – is processed by, and is toxic to, the liver, and in line with NHS information, The Hepatitis C Trust advises that‘ without doubt, the most effective measure anyone infected with hepatitis C can take to slow down disease progression is to avoid drinking alcohol’.
The severity of liver disease in people with HCV is much greater among those who drink –‘ this has been seen in rates of fibrosis, the development of cirrhosis, the incidence of liver cancer and finally in survival rates’, says the Trust, and most doctors caring for people with HCV will urge them to stop drinking completely. While heavy drinking can clearly do its own, independent damage to the liver – as well as exacerbating the damage caused by the virus – it is also thought that alcohol consumption can increase the viral load of someone with HCV and contribute to a poorer response to antiviral treatment.
As well as putting stress on the liver themselves, many illicit drugs will contain impurities that can also be toxic, and drugs that are injected are likely to put a greater strain on the liver as they will not have been filtered via the stomach.
Those infected are also advised to exercise and eat a healthy diet.
WHO Regional Office for Europe
10
interim 2020 targets
50 % of people living with chronic HCV infections diagnosed and aware of their condition
75 % treatment coverage of people diagnosed with HCV infections who are eligible for treatment
75 % of those at late stage of viral hepatitis-related liver disease( cirrhosis or liver cancer) diagnosed
“
... the most significant development in recent years is NHS England’ s strategy to eliminate the virus by 2025
increasing year-on-year 9 and this is already thought to have led to an 11 per cent fall in the number of deaths. 1
Operational delivery networks( ODNs) have also been established across England to drive improvements in treatment and increase access, and a National Hepatitis C patient registry has been established to record and monitor diagnosis rates, treatment uptake and outcomes. PHE has also set up a National Strategic Group on Viral Hepatitis( NSGVH), and its Hepatitis C in England: 2018 report serves as a useful overview of the situation, setting out recommendations for improving prevention and harm reduction, boosting testing and diagnosis rates, and increasing access to treatment. 1
The challenge remains substantial, however. A 2018 report from the All Party Parliamentary Group( APPG) on Liver Health concluded that‘ significantly greater’ numbers of people will need to be tested, diagnosed and treated in order to eliminate the virus. 10 Awareness levels among the public remain low, it found, while budget pressures are also having a negative impact on local testing and prevention initiatives. 10
The APPG report is calling for treatment to be made‘ universally accessible’ and available in community settings. It also wants to see the widespread introduction of‘ opt-out’ testing in drug treatment services. Contributors to the report‘ overwhelmingly agreed’ that, as things stand, England is not on track to achieve either the NHS or WHO elimination targets, and it calls for urgent agreement on a‘ national elimination strategy’ for the virus. www. drinkanddrugsnews. com Wider Health Series | DDN | 3