9261 HEPATITIS C REPORT GALLEY - North West Public Health ...

S UMMARY
Viruses such as HIV, hepatitis C and hepatitis B that are transmitted in the blood pose
a major health threat for people who inject drugs. Hepatitis C is a particular cause for
concern for several reasons. Firstly, its prevalence is extremely high among injecting
drug users (IDUs) (reported levels range between 60 - 80%). Secondly, no vaccine is as
yet available, and the rapid mutation rate of the virus makes the imminent
development of one unlikely. Thirdly, treatment is often ineffective, with even the most
advanced treatment available clearing the infection on only 40% of occasions. Finally,
a high proportion of cases (around 80%) become chronically infected, and of these,
around 20% go on to develop serious liver damage, such as cirrhosis or hepatic
carcinomas. Because individuals can have many years of asymptomatic infection before
presenting to health services with chronic disease, the scale of the problem is hard to
assess. Moreover, in IDUs infection with multiple strains of hepatitis C or co-infection
with hepatitis B or HIV is common, and this exacerbates damage to the liver.
In the wake of the HIV crisis and the provision of needle exchange schemes, IDUs
reduced the levels of high risk sharing behaviour. However, hepatitis C is much more
efficiently transmitted in small amounts of blood, and infections occur via indirect
sharing of other injecting paraphernalia. At present there is no national strategy for
the screening and treatment of IDUs. Treatment requires a high level of compliance,
and has unpleasant side effects such as depression. Since IDUs often display chaotic
behaviour, they are generally not considered suitable for treatment. However, taking a
hepatitis C test and the counselling that accompanies it may represent an opportunity
for addressing risk behaviours and possibly stabilising drug use.
Aims
Reviewing current knowledge about hepatitis C epidemiology reveals a number of
factors that are at present unmeasured but necessary to implement effective and
economic policies for hepatitis C prevention and treatment. Key amongst these is the
level of infection in wider drug injecting communities in the North West (not just those
requesting a test or in treatment at specialist drug agencies). Equally however,
additional data are needed on the risk behaviours associated with infection and
information is required on whether and how individuals change such behaviour once
aware of their hepatitis C serostatus. Consequently, a group of IDUs in the North West
were recruited in order to:
1. compare the prevalence of hepatitis C among drug users accessing different types
of service, and among drug users not accessing services
2
H EPATITIS C IN INJECTING DRUG USERS IN THE N ORTH W EST