NHS hepatitis C guidance updated

NICE reacts to ‘growing hepatitis C problem’
By Tim Locke
WebMD Health News

Reviewed by Dr Rob Hicks

22nd September 2010 - The NHS regulator, NICE, has updated guidance on the treatment of hepatitis C. This covers the use of peginterferon alfa (2a or 2b) and ribavirin for the treatment of chronic hepatitis C.

This new guidance reflects changes in licensing and recommends their wider use and, where appropriate, shorter treatments for adults with the disease.

Hepatitis C

Estimates from the Health Protection Agency suggest that approximately 142,000 people between the ages of 15-59 years had chronic hepatitis C (HCV) in England and Wales in 2003. More than 90% of all newly diagnosed infections in the UK occur in injecting drug users.

People infected with HCV often don’t have any symptoms, but about 20% will develop acute hepatitis and will experience symptoms such as malaise, weakness and anorexia. About 80% of those infected with the virus go on to develop chronic hepatitis.

The rate of progression from mild to severe disease is slow, taking about 20-50 years from the time of infection. About 30% of infected people develop cirrhosis within 20-30 years, and some of these people are at a high risk of developing hepatocellular carcinoma. Some people with end-stage liver disease or hepatocellular carcinoma may require liver transplants.

Revised guidance

The National Institute for Health and Clinical Excellence (NICE) guidance advises that:

• Combination therapy with peginterferon alfa (2a or 2b) and ribavirin is recommended as a treatment option for adults with chronic hepatitis C who have been treated previously with peginterferon alfa (2a or 2b) and ribavirin in combination; or with peginterferon alfa monotherapy, and whose condition either did not respond to treatment, or responded initially to treatment but then relapsed; or for adults who are also infected with HIV
• Shortened courses of combination therapy with peginterferon alfa (2a or 2b) and ribavirin are recommended for the treatment of adults with chronic hepatitis C who have a rapid virological response to treatment at week 4 that is identified by a highly sensitive test, and who are considered suitable for a shortened course of treatment. 

Many people ‘have no idea they have it’

A recent All Party Parliamentary Hepatology Group report on hepatitis C identified the disease as being one of the main reasons for the large rise in the number of people dying from liver disease. The report estimates that there could be as many as 466,000 people living with hepatitis C in the UK.

Sir Andrew Dillon, NICE Chief Executive, says in a statement: “Many people exposed to the disease have no idea they have it since it can remain symptomless for many years. However, hepatitis C is a potentially debilitating condition, and about 80% of those with the virus go on to develop chronic hepatitis, sometimes as long as 50 years after they were first infected. By widening access to these drugs, this guidance will give clinicians and people living with hepatitis C more treatment options.”

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