The
prevalence of hepatitis C in England fell by almost 40% between 2015 and 2020
and deaths due to the virus fell by 35% in the same period, the UK Health
Security Agency reported last week.
“In
England, we are on our way to eliminating hepatitis C as the number of deaths
continue to decline and direct acting antiviral drugs are available that will
clear the virus in around 95% of people who complete treatment,” said Dr Helen
Harris, Chief Scientist at the UK Health Security Agency (UKHSA).
The UKHSA
report estimates that hepatitis C prevalence has fallen from around 129,000 in
2015 to around 81,000 in 2020 – a 37% fall in the general population.
Modelling
by UKHSA estimates that 27% of the chronic infections are in people who have
recently injected drugs, 62% are in those with a past drug injecting history
but who are no longer injecting and 11% are in those with no history of
injecting drug use.
The UKHSA
modelling estimates that the prevalence of hepatitis C among people who inject
drugs in England has fallen from 28% in 2015 to 17% in 2020 – a 40% decline in
prevalence.
Despite a
doubling in testing activity in drugs services between 2015 and 2020, UKHSA
estimates that 60% of people who inject drugs living with hepatitis C in 2020
were unaware of their infection in 2020.
The
reduction in prevalence has been largely achieved by increased access to
treatments, with around 58,850 treatments taking place between April 2015 and
the end of March 2021.
UKHSA
says that there has been little change in the rate of new infections among
people who inject drugs in England since 2015. The availability and uptake of harm
reduction measures including sterile injecting equipment and opioid
substitution treatment remain sub-optimal.
Only 62%
of people who inject drugs reported that they were able to obtain adequate
supplies of sterile needles and syringes and the proportion of people who
reported sharing injecting equipment remained unchanged between 2015 and 2020
(20% and 24% respectively).
The re-infection
rate among people who inject drugs is 11%, indicating a need for intensified
harm reduction support for people during and after hepatitis C treatment.
Deaths
due to advanced liver disease related to hepatitis C fell from 482 in 2015 to
314 in 2020 – exceeding the World Health Organization target for a 10% drop by
2020. New cases of hepatocellular carcinoma caused by hepatitis C fell by 21%
and new cases of end-stage liver disease caused by the virus fell by 16% since
2015, suggesting that treatment is averting late-stage complications of
hepatitis C as well as deaths.
Liver transplants
in people with cirrhosis due to hepatitis C fell by 40% and only 6% of liver
transplants carried out in England in 2020 was due to hepatitis C, compared to
12% in 2015.