HEPATITIS C
TESTING TIMES
IDENTIFYING POTENTIAL PROBLEMS
It ’ s clearly vital that those at risk of HCV infection have access to testing and , if necessary , treatment . However stigma , chaotic lifestyles and patchy service provision can still be significant barriers
LONG-TERM HEALTH ISSUES FACING PEOPLE WITH UNTREATED HCV
One in five people who become infected with hepatitis C will naturally clear the virus themselves , but for the other 80 per cent it ’ s vital to seek treatment .
If left untreated , hepatitis C can sometimes cause scarring of the liver ( cirrhosis ), where the scarring has taken place to such an extent that it has altered the structure of the liver , rendering it nodular and lumpy and compromising the free flowing of blood in the organ .
Chronic infection with hepatitis C can also lead to cirrhosis , although the time this can take will vary from person to person . Between 20 and 30 per cent of people with a chronic hepatitis C infection will develop cirrhosis within 20 years , although for other people it can take much longer . 2
There are two stages of cirrhosis – ‘ compensated ’, when the liver is still able to function and cope with the ongoing damage – and ‘ decompensated ’, when it ceases being able to cope or function properly . 2 Without treatment compensated cirrhosis will almost certainly lead to decompensated cirrhosis although , again , the rate at which this happens will vary .
Among the health issues people with compensated cirrhosis will face are tiredness , weakness , loss of appetite , nausea and vomiting . Once the cirrhosis has progressed to the decompensated stage and the liver is no longer able to function properly , people will face serious health problems that can require hospital treatment , such as jaundice , ascites ( accumulation of fluid in the abdomen ), internal bleeding and hepatic encephalopathy , when the liver ’ s inability to filter
toxins leads to them building up in the brain . People can also go on to develop liver cancer , for which the five-year survival rates in England post-diagnosis are around 12 per cent . 3
While it ’ s important for people with hepatitis C to stop drinking , eat well and adopt a healthy lifestyle , those with entrenched drug problems will often be in marginalised communities and live chaotic lives . Many will have little contact with primary care or specialist drug services , which means treatment – or even testing – for HCV can be difficult to carry out .
PROACTIVE SUPPORT
A key element of NHS England ’ s hepatitis C strategy is to identify more people living with the virus , and one effective means of achieving this is through proactive outreach and testing in the community . The APPG on Liver Health ’ s report called for the introduction of ‘ opt-out ’ testing for hepatitis C in drug treatment services ( which means that services users are routinely tested unless they explicitly refuse consent ), while pilot projects offering testing in pharmacies have also shown impressive results . 4
A 2018 report from the London Joint Working Group ( LJWG ) on Substance Use on the results of a four-month pilot programme at nine pharmacies with needle exchange facilities found that more than 50 per cent of those tested had HCV antibodies in their blood . 4 Many of those taking part in the scheme would have been unlikely to engage with a GP service to request testing , and 84 per cent of participants also reported that they would be happy to receive treatment for the virus at their local pharmacy . 4
Key harm reduction messages that professionals can give to clients with HCV
Try to avoid illicit substances as they are toxic to the liver , but if you are going to snort drugs do not share straws or banknotes
Take regular exercise and try to maintain a positive mental attitude
Do not share crack pipes
4 | DDN | Wider Health Series