Hepatitis C diagnosis and management: a primary care and public health partnership approach

Mark Dermont; Raymond Sullivan; Bharat Sibal; Graham Foster; Sema Mandal

doi:10.3399/bjgp22X718529

INTRODUCTION

Hepatitis C virus (HCV) remains a major public health threat. HCV is a contagious bloodborne viral infection that affects the liver and can lead to cirrhosis and cancer. There is no vaccine available and infection may be asymptomatic in its early stages. The risk of transmission can be reduced substantially through modifiable health behaviours and prompt treatment. With new direct-acting antiviral treatments (DAA), HCV is curable in the vast majority of people but, despite this, many individuals remain undiagnosed and untreated.¹ Healthcare services and public health are committed to eliminating HCV in England and effective therapy is now available to everyone who is infected.

EPIDEMIOLOGY IN THE UK

Official estimates are that around 89 000 people in the UK were living with chronic HCV in 2019, many of whom are some of the most vulnerable and marginalised people in society such as people who inject drugs (PWID), prisoners, the homeless, and migrants from endemic countries.² A high proportion of those living with HCV are thought to be undiagnosed and this underlines the importance of continued efforts to find and treat these individuals, as most GPs will have several infected people registered at their practice.

The use of DAA drugs has increased as their costs have fallen, transforming the treatment landscape. Combining DAA treatments with harm reduction strategies and sustained testing offers the possibility of eliminating HCV as a major public health threat in line with World Health Organization goals.³^,⁴

Scaled up and improved access to DAA treatment likely contributed to HCV infection in the UK decreasing by more than 20% between 2015 and 2019, and a 19% …

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