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