Leaving Hepatitis C undetected can lead to severe complications.
A Hepatitis C infection can be categorised into two stages. The first stage is acute infection (following initial infection). The second stage is chronic infection. The acute stage refers to the first 6 months of infection and does not necessarily result in any noticeable symptoms.
Approximately 20% of those infected with Hepatitis C will naturally clear the virus from their body within the first six month. For the remaining 80%, a chronic (long-term) infection will develop.
The course of a chronic Hepatitis C infection is extremely varied and unpredictable. Some people experience very few symptoms for as long as a decade. Others can suffer symptoms almost from the start.
In some people, the infection will progress to development of fibrosis and cirrhosis (scarring) of the liver, liver cancer or end stage liver disease, while others experience very little liver damage, even after many years.
In cases where there is an absence of symptoms, many people do not discover that they have HCV until some time after they have been infected.
Another reason that Hepatitis C goes undiagnosed for many years is that its symptoms can often be put down to other illnesses. For example, depression, fatigue, skin problems, insomnia, pain and digestive disorders could all have other causes. For these reasons, Hepatitis C is often referred to as the ‘Silent Epidemic’.
It is clear from this that, for those 80 percent who do not naturally clear the Hepatitis C virus from their bodies, the failure to detect and then adequately treat the infection can have devastating consequences including the need for liver transplant, or death.
It is not unreasonable, considering the fact that there is now increased publicity around the risks of Hepatitis C and indeed a national campaign underway to test for and diagnose Hepatitis C, that increased numbers of people will be aware of this infection and will be seeking ways to be tested for it.
Although the incidence of Hepatitis C in the UK is relatively low, a study conducted using residual sera collected as part of the HPA Sero-epidemiology programme suggested that around 106,000 individuals became infected with Hepatitis C between 1986 and 2001 (HPA 2009 report Hepatitis in the UK).
Primary prevention of Hepatitis C infection involves a variety of practical measures, some aimed particularly at risk groups, and other more general measures to ensure that the national blood supply is safe through donor selection and screening.
Unfortunately, many people living with Hepatitis C are unaware of their infection status, resulting in a silent reservoir of infection in society.
An important part of the overall strategy to control Hepatitis C is to improve awareness of the infection and encourage testing in risk groups. Once diagnosed, effective treatment can help eliminate a persistent infection in some patients, and so reduce the number of infected individuals.
Treatment before the onset of recognisable disease reduces the progression to late complications of infection. Patients who respond to therapy by clearing the virus can avoid the risk of serious liver damage.
Among patients who do not respond to therapy, the risk of developing long-term liver damage can be reduced by modifying other risk factors, such as alcohol consumption and avoiding infection with other hepatitis-causing viruses.
Having a clear strategy is only the first step in achieving a real impact. Equally important is the delivery of interventions and review of their efficiency.
Progress made to date varies from country to country, reflecting the different stages of implementation of control programmes and the different approaches taken in the different administrations. A four nations approach will encourage the sharing of good practice and help to identify best practice.
Fortunately, due to the improved treatment available nowadays, less cases of Hepatitis C infection in the UK become fatal. According to Government statistics, deaths from Hepatitis C-related end-stage liver disease fell by 11% in 2017 compared to the previous year. However, the need for early diagnosis and treatment is still very prevalent.
It is clear from the above facts and report from both the Hepatitis C Trust and the Health Protection Agency that there is a very considerable health gain from the detection of a Hepatitis C infection. This is not only for the the individual in whom the infection is detected, but also for society. The detection of each case of Hepatitis C can lead to treatment and the prevention of onward transmission of the disease.