Deaths from end-stage liver disease due to HCV fall in United Kingdom

22 Aug 2018 Keith Alcorn
Originally published on www.infohep.org

Deaths from end-stage liver disease and liver cancer caused by hepatitis C in the United Kingdom fell by 11% in 2017, provisional figures from Public Health England released on 28 July show.

Most of the decline was the result of a reduction in deaths from end-stage liver disease, not liver cancer, Public Health England says, and took place at the same time as a 19% increase in the number of people who received direct-acting antiviral (DAA) treatment. Public Health England says that the United Kingdom is on track to achieve the World Health Organization’s target of a 10% reduction in hepatitis C virus (HCV)-related mortality by 2020.

Just over 14,000 people started DAA treatment from April 2017 to March 2018, an increase of 19% on the previous year and a doubling of the number of people receiving treatment for hepatitis C compared to 2014. Public Heath England warns that the biggest obstacle to further increases in the number of people accessing treatment will be the ability of the NHS, harm reduction and drug treatment services to diagnose and link to care people with undiagnosed hepatitis C.

The Unlinked Anonymised Monitoring survey found that of people who had hepatitis C antibodies, 72% reported ever having seen a hepatologist and of these, 42% reported ever having been offered treatment for hepatitis C.

The survey also found that approximately two-thirds of people who inject drugs who have hepatitis C antibodies are aware of their positive status. As the majority of people with hepatitis C in the United Kingdom acquired hepatitis C through injecting drug use, this finding suggests that the United Kingdom has already met the World Health Organization target of 50% of infections diagnosed.

However, prevention of new infections among people who inject drugs is still sub-optimal. If prevention services are adequate and reaching people soon after they begin injecting drugs, the proportion of people new to injecting who have acquired hepatitis C should decline over time.

The Unlinked Anonymised Monitoring survey found no change over the past decade in the proportion of people who recently started injecting who tested positive (22% in 2017 compared to 24% in 2008). Surveys have also found some evidence to suggest that the rate of new infections among people who inject drugs may have risen since 2011. Furthermore, the survey found that two out of five people who inject drugs reported that they did not have access to enough sterile syringes and needles for their injecting needs in 2017.

Public Health England says that “a radical change in the response to HCV among PWID [people who inject drugs] is required” if the United Kingdom is to achieve the 2020 World Health Organization target of a 30% reduction in new HCV infections by 2020, let alone the target of an 80% reduction by 2030.