UK Doctors warn of death toll from 'silent epidemic' of hepatitis C
By Jeremy Laurance Health Editor
01 January 2004

Hospital specialists criticised the Government yesterday for failing
to act to curb the spread of hepatitis C, a lethal blood-borne virus.

The silent epidemic of hepatitis C is officially estimated to have
infected 200,000 people in the UK - four times as many as HIV - and
more than 100 people are being infected each week.

It is already the main reason for liver transplants and is predicted
to be killing more people than Aids by 2020, yet only a quarter of
victims know they are infected and just 1 per cent are receiving
treatment.

The seriousness of the threat was recognised by the Department of
Health when it published a strategy for dealing with the epidemic 18
months ago and promised an action plan by the end of 2002. But a
year later nothing has been done.

Graham Foster, professor of hepatology at the Royal London Hospital,
said: "There is much disappointment at the lack of an action plan.
Absolutely nothing is happening."

A new study, to be published shortly, will show a dramatic increase
in the number of new infections, Professor Foster said. Last month,
the Health Protection Agency revealed that 5,901 cases of hepatitis
C infection were diagnosed in 2002, compared with fewer than 1,000
in 1994.

"The figures are horrifying. Over the next 10 to 15 years liver
disease and cancer rates will soar. The Government is talking the
talk but it is doing nothing else," Professor Foster said.

The outlook for sufferers has been transformed in the past decade as
new drug cocktails have increased the proportion of patients who can
be cured to 60 per cent. Other countries have established programmes
to identify and treat patients. France treats 15,000 patients a year
compared with 2,000 a year in Britain.

"In the UK we are just discussing it and hoping it will go away,"
Professor Foster said.

Most victims are unaware they are infected, but up to 30 per cent
will suffer severe symptoms caused by chronic inflammation of the
liver including cirrhosis, liver cancer and death over two to three
decades.

William Irving, professor of virology at Nottingham University, said
Britain was one of the few countries with a policy on hepatitis C.

"But it is disappointing we haven't seen an implementation plan or
any funding for an implementation plan. There are a lot of people
out there with hepatitis C and there is a window of opportunity to
treat them now before they develop liver disease."

One reason for neglect of the disease is thought to be its "low-
life" association with intravenous drug use - it is spread by shared
needles.

But increasingly it is also being spread by "social" drug use such
as snorting cocaine. Straws used to snort cocaine are often passed
around and may become contaminated by blood from the nasal
epithelium caused by the corrosive, alkaline nature of the drug.

The virus can also be spread through sex, though this is rare, and
through skin piercing, tattooing and shared use of razor blades and
toothbrushes. It is 10 times more infectious via blood-to-blood
contact than HIV, but less infectious than HIV via sexual contact.

Many victims became infected through experimenting with injecting
drugs decades ago and now lead stable lives with families and jobs.
Others were infected through blood transfusions.

The virus was identified in 1989 but screening of blood was not
introduced until 1991, and many sufferers do not know how they
became infected.

Charles Gore, chief executive of the Hepatitis C Trust, said: "There
was a lot of experimentation with intravenous drug use at the end of
the Seventies and early Eighties - far more than most people think.
There was a huge influx of heroin after the Iranian revolution in
1979 and experimentation involves someone showing you how to do it
and using their syringe. Now those people are starting to come
through with chronic liver disease.

"The Government is dragging its feet on this - there is a lack of
political will and a fear of the cost implications."

A treatment based on interferon can eliminate hepatitis C from the
body, and a new slow-release version was recommended by the National
Institute for Clinical Excellence last month. But the virus is
symptomless in its early stages, meaning efforts have to be made to
test and identify those infected. There is also a shortage of
trained nurses able to give the treatment which lasts up to a year.

A spokeswoman for the health department said: "The hepatitis C
action plan will be published in due course."