Mon 21st July 2014

World Hepatitis Day doesn’t get the coverage of World AIDS day…

...but globally the twin diseases of hepatitis C and B are thought to affect nearly one in 12 people across the globe.

Of course, we don’t know the real figures because much of the disease is undiagnosed, and that is part of the problem. Both infections tend to be silent when they are first acquired, but cause problems over many years, leading to severe liver disease often only decades later. They deserve a much higher profile and recognising World Hepatitis Day is one way of raising that profile.

Hepatitis C has been in the news a lot recently. And generally the news has been good. There have been a series of drug trials over the last year (and many more still in progress) which have shown great promise. We will discuss some of these in this blog in future posts, but overall it looks like drug treatments have been developed which are very effective, pill-only, avoid interferon therapy, are easy to take, courses often lasting about 3 months. Even 3-4 years ago such treatments seemed a very long way off but they have come quickly and there are various versions being developed which it is hoped will provide plenty of options for those who can access them. But the last bit is the problem. The treatments so far are expensive and it will take some period of discussion and negotiation to make them available to those who need them in the UK, let alone in many countries round the globe with less money to spend on health. But for the sickest UK patients an early access programme is already up and running, which means those who are at the most severe end of the spectrum of liver damage caused by HCV can be treated now with some of these new drugs at specialist centres across the country.

With better treatments emerging, this does throw the spotlight back on who is coming forward for testing and therapy. Up till now, the process of treatment has been complicated and the side-effects are well known. If we turn hepatitis C into a disease which is treated simply and successfully, hopefully we can lower some of the barriers that currently exist. Developing new tests and treatments is only part of the solution – increasing awareness and education has an equally important role to play.

With all the focus on hepatitis C, we should not forget on World Hepatitis Day about hepatitis B, which infects even more people round the world. This is despite the fact we have a good vaccine and effective drugs. The drugs are usually very effective at suppressing virus – and halting disease - but unlike the HCV drugs they do not usually lead to a lasting cure so may need to be taken life-long. Developing new strategies and treatments which can lead to an effective cure for hepatitis B remains an important goal for the future. Like hepatitis C, though, good education and raising awareness has to be the starting point too.

There are many parts of the world where World Hepatitis Day might pass unnoticed – if so this is a missed opportunity because it will include areas where hepatitis C and B are both common. Poorer countries with less robust health care systems will be lagging behind with the roll-out of newer treatments for these infections, but they mustn’t be forgotten. Both diseases are truly global health problems. I hope World Hepatitis Day 2014 marks a point where we begin to really pin these viruses back and start out on the long road to eradication.

Prof Paul Klenerman
Prof Paul Klenerman