Published: 01/07/2004, Volume II3, No. 5912 Page 29

What is it?

A viral infection that attacks the liver. At the time of infection it rarely shows symptoms, but around 80 per cent of sufferers become chronically infected. About 20 per cent of these go on to develop serious liver disease and a small number develop cancer.

People can have the virus for more than 20 years before serious illness tells them something is wrong.

Who gets it?

It is passed on through blood-to-blood contact. People who had a blood transfusion before the introduction of blood screening in 1991 may be infected. It is also thought to be present in 50-80 per cent of injecting drug users through the sharing of injecting equipment (once can be enough). Sexual transmission, tattooing and piercing as well as toothbrushes, razors and cocaine straws are among other possible routes of transmission.

How common is it?

Information on prevalence and incidence is very poor. Estimates of the numbers of people infected in the UK vary from about 240,000 (0.4 per cent) to 600,000 (1 per cent). It is thought to be up to 10 times more prevalent than HIV because it is more infectious and it was already established in the drug-using population before the advent of needle exchange.

Is there a cure?

Yes, thanks to increasingly effective antiviral drugs. Combination therapy using pegylated interferon and ribavirin can cure 50-80 per cent of people with moderate to severe chronic hepatitis, depending on the viral 'strain' or genotype. NICE has recommended this treatment as being cost effective, but at a cost of an extra£10m a year - and That is just for the small numbers of people already diagnosed.

Lifestyle changes can also lessen the chances of serious illness.

So how is the problem being tackled?

In the UK, apart from Scotland, there is still no national strategy.

Awareness of the disease is low among the public and also primary care professionals. A survey in 2003 by Southampton University revealed patchy services, key barriers including lack of funding and a shortage of specialist staff.

Any success stories?

France instigated a national strategy back in 1999. The first phase had a three-year budget of 227m for a programme of awareness-raising, testing, treatment, care management and research. France is now in phase two, having diagnosed half of those infected. By 2005, it aims to have diagnosed 100 per cent.

Who is doing it well in this country?

A number of places are setting up managed clinical networks for hepatology, the most established being in the South West and West Midlands. Plymouth recently launched a hepatitis strategy and action plan, and Bristol has its own strategy and is also piloting a community integrated care pathway. Gloucester has a good IT prototype for managing hepatitis C. These are a few examples.

Others include needle exchanges, consultant outreach clinics and mobile testing services.