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