Hepatitis C carriers must be found and treated to avert crisis
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《英国医生杂志》
London
Considerable extra resources to improve detection and treatment rates for hepatitis C are urgently needed to avoid a public health crisis that could overwhelm liver units, says new guidance from the Royal College of Physicians of Edinburgh.
It calls for high priority to be given to finding cases among former injecting drug users, for the development of new, community based and specialist nurse led services, and for broader access to treatment.
The guidance also says it is no longer essential to carry out a liver biopsy to determine the selection of patients.
The hepatitis C virus is thought to have infected up to 600 000 people in the United Kingdom and up to 200 million worldwide. It is estimated that up to a fifth of carriers of the hepatitis C virus could develop cirrhosis and need liver transplantation.
Consultant gastroenterologist Professor Peter Hayes from the Royal College of Physicians of Edinburgh said it was certain that "if we do not invest adequately now, we will not be able to afford the consequences of failing to tackle this epidemic."
He said services had to be redesigned, that clinics had to improve their attendance rates (as non-attendance was around 50%), and that measures such as treatment in prisons needed to be examined.
The guidance says a new, community focused model of care is needed, using outreach nurse led clinics in primary care, prisons, and drug treatment services. It also says healthcare workers need training and GPs need clear guidelines about suitability for referral.
Charles Gore, chief executive of the national charity Hepatitis C Trust, said the guidance was very welcome and that public awareness was key to increasing detection rates. He said: "We are very aware that huge numbers are not yet diagnosed. One of the key things we want to do is identify people. You can't afford to ignore this. Managing end stage liver disease is so expensive and so labour intensive.
"Managed clinical networks are a key point, and patient groups are saying this is what we need. You can really change your life expectancy by looking after yourself, and that doesn't cost much, except setting up support networks."
The primary aim of treatment for hepatitis C is viral clearance. A sustained viral response is defined as the absence of hepatitis C virus RNA in serum 24 weeks after the end of treatment.
Combination therapy with pegylated interferon alfa and ribavirin is recommended for all patients suitable for treatment. Patients with genotypes 1 and 4-6 should receive therapy for 48 weeks and genotypes 2 and 3 for 24 weeks. In genotype 1, quantitative polymerase chain reaction (a test of viral load) at 12 weeks will determine if patients continue therapy.(Paul Stephenson)
Considerable extra resources to improve detection and treatment rates for hepatitis C are urgently needed to avoid a public health crisis that could overwhelm liver units, says new guidance from the Royal College of Physicians of Edinburgh.
It calls for high priority to be given to finding cases among former injecting drug users, for the development of new, community based and specialist nurse led services, and for broader access to treatment.
The guidance also says it is no longer essential to carry out a liver biopsy to determine the selection of patients.
The hepatitis C virus is thought to have infected up to 600 000 people in the United Kingdom and up to 200 million worldwide. It is estimated that up to a fifth of carriers of the hepatitis C virus could develop cirrhosis and need liver transplantation.
Consultant gastroenterologist Professor Peter Hayes from the Royal College of Physicians of Edinburgh said it was certain that "if we do not invest adequately now, we will not be able to afford the consequences of failing to tackle this epidemic."
He said services had to be redesigned, that clinics had to improve their attendance rates (as non-attendance was around 50%), and that measures such as treatment in prisons needed to be examined.
The guidance says a new, community focused model of care is needed, using outreach nurse led clinics in primary care, prisons, and drug treatment services. It also says healthcare workers need training and GPs need clear guidelines about suitability for referral.
Charles Gore, chief executive of the national charity Hepatitis C Trust, said the guidance was very welcome and that public awareness was key to increasing detection rates. He said: "We are very aware that huge numbers are not yet diagnosed. One of the key things we want to do is identify people. You can't afford to ignore this. Managing end stage liver disease is so expensive and so labour intensive.
"Managed clinical networks are a key point, and patient groups are saying this is what we need. You can really change your life expectancy by looking after yourself, and that doesn't cost much, except setting up support networks."
The primary aim of treatment for hepatitis C is viral clearance. A sustained viral response is defined as the absence of hepatitis C virus RNA in serum 24 weeks after the end of treatment.
Combination therapy with pegylated interferon alfa and ribavirin is recommended for all patients suitable for treatment. Patients with genotypes 1 and 4-6 should receive therapy for 48 weeks and genotypes 2 and 3 for 24 weeks. In genotype 1, quantitative polymerase chain reaction (a test of viral load) at 12 weeks will determine if patients continue therapy.(Paul Stephenson)