Nearly half of people with hepatitis C in the United States are not tested for the virus until they develop clinical signs and symptoms such as elevated liver enzymes or jaundice, according to a study published in August. These findings support US guidelines issued in 2012 advising all 'baby boomers' born between 1945 and 1965 to be tested, regardless of risk factors.

In Europe, testing for hepatitis C is recommended for people who have known risk factors for hepatitis C infection. Recommendations vary from one country to another. In most countries, testing is recommended for people who have injected drugs in the past, and for people who currently inject drugs. However, the 2012 Euro Hepatitis Care Index Report published by ELPA (the European Liver Patients Association) found that in 8 out of 30 countries in western and central Europe there was no systematic screening for people who currently inject drugs, despite the high risk of exposure to hepatitis C through the sharing of injecting equipment.

Testing is recommended in most countries for people who received blood transfusions or blood products prior to 1989.

These variations between European countries suggest that the proportion of people who are diagnosed with hepatitis C only when they develop symptoms of liver damage is likely to be just as high in Europe as in the United States.

Early diagnosis of hepatitis C is essential in order to limit the progression of liver damage caused by the virus. Currently available hepatitis C treatment is more likely to clear the virus if it is given before the development of cirrhosis. Diagnosing hepatitis C before the development of cirrhosis enables people to choose to undergo a course of treatment when the chances of a cure are higher.

Medivir, a Swedish pharmaceutical company, is developing a new hepatitis C protease inhibitor called simeprevir in partnership with Janssen. Simeprevir is likely to receive European marketing approval in 2014.

Meanwhile, Gilead Sciences is developing sofosbuvir, a nucleotide analogue. Sofosbuvir is also likely to receive European marketing approval in 2014.

There is considerable interest in the potential for using simeprevir and sofosbuvir in combination with ribavirin, as an interferon-free combination for the treatment of genotype 1 hepatitis C infection.

Preliminary results of a study of the combination were released in March and in May. These results showed that in people with less serious liver disease, very high rates of sustained virologic response were seen four and eight weeks after completing treatment. Twelve-week SVR results are required before participants in this study can be considered cured.

In August, Medivir released interim results of a study of this combination in a hard-to-cure group of patients with advanced liver fibrosis or cirrhosis. Participants in the study were either untreated or previous null responders. They received a 12-week course of treatment with or without ribavirin. Four weeks after the completion of treatment, 96% of those who received ribavirin and 100% of those who did not receive ribavirin had a sustained virologic response (SVR).

Full details of this study are likely to be presented at the American Liver Meeting in November.

Further studies will be needed before the two drugs can be prescribed together, but these preliminary results suggest that interferon-free treatment may become an option for some patients when these two drugs become available.

Activists in Ukraine have achieved an important victory in their campaign for access to hepatitis C treatment. The Ukrainian Cabinet of Ministers has agreed to allocate 3 million euros for a national hepatitis plan. This will enable people in urgent need of hepatitis C treatment to receive pegylated interferon and ribavirin.

However, the cost of hepatitis C treatment remains a major obstacle to access in eastern Europe and central Asia. A coalition of 83 organisations in the region has called on manufacturers Merck and Roche to reduce the cost of a 48-week course of pegylated interferon from around USD 15,000 to USD 2000.

Infant vaccination against hepatitis B has significantly reduced the number of deaths due to liver disease and liver cancer in Taiwan, new research shows. Taiwan implemented a national policy of infant vaccination in 1984 when a hepatitis B vaccine first became available. Like many countries in Asia, Taiwan had a high prevalence of hepatitis B.

The World Health Organization recommends universal infant vaccination, but five countries – including the United Kingdom – do not offer hepatitis B vaccination on the grounds that universal vaccination is not cost effective.

There are also big variations in vaccination policies for people at high risk of hepatitis B infection. Although vaccination for healthcare workers is almost universally available in the European Union (with the exception of Estonia), vaccination is not routinely offered to men who have sex with men, commercial sex workers or prisoners in many European countries. Eleven countries in western and central Europe – including The Netherlands – do not routinely offer the vaccine to people who inject drugs, despite the high risk of hepatitis B transmission through shared injecting equipment.

You can find out more about vaccination policies and coverage for different population groups by consulting the Euro Hepatitis Care Index.

We aim to provide a comprehensive online database of organisations offering services to people with hepatitis or working in the field of viral hepatitis. We already list nearly 200 services in the European and Eastern Mediterranean region. You can also search for services by country.

Check the infohep database of services and organisations working in viral hepatitis to find out whether your organisation is already listed.

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