Hepatitis C in England: deaths decline but new infections steady since 2011

The number of people with chronic hepatitis C infection in England has fallen by 30% since 2016 due to direct-acting antiviral treatment, says Public Health England in a new report on the hepatitis C epidemic.

Around 89,000 people are living with the hepatitis C virus (HCV) in England, Public Health England estimates.

HCV-related mortality and morbidity continue to decline. The proportion of liver transplants that are carried out due to hepatitis C has halved since 2009. The proportion of people on the liver transplant waiting list due to cirrhosis caused by hepatitis C has fallen by 44% compared to pre-2015 levels.

Deaths from liver disease caused by hepatitis C (including liver cancer) fell by 20% between 2015 and 2018. Deaths among people with hepatitis C from all causes fell by 34% over the same period. England achieved the World Health Organization (WHO) target of reducing HCV-related deaths by 10% three years ahead.

Public Health England says that the WHO target of reducing HCV-related deaths by 65% by 2030 looks achievable in England if the number of people treated continues to rise.

Improving the rate of hepatitis C diagnosis will be essential for achieving the WHO target.

Public Health England’s anonymised monitoring of hepatitis C infection in people who inject drugs found that 61% were aware of their positive HCV antibody status in 2018. Fifty-three per cent were aware of chronic HCV infection. WHO has set a target of 90% of people with hepatitis C aware of their infection by 2030, indicating the need for increased testing of people with risks for hepatitis C.

Overall, the number of people tested for hepatitis C rose by 28% between 2014 and 2018, with much of the increase in testing concentrated in sexual health services, prisons and drugs services. After a doubling in numbers tested in drugs services between 2014 and 2016, testing has fallen off by 14% between 2016 and 2018.

Twenty-eight per cent of people who inject drugs have chronic HCV infection and this has remained stable in recent years – this is attributable to treatment clearing infections rather than harm reduction preventing infections, the report says.

Public Health England emphasises the importance of offering HCV testing in drugs services, and of ensuring that a single sample can be used for antibody testing and confirmatory RNA testing, to streamline diagnosis and enable more rapid referral for treatment.

NHS England reports that 11,756 people were treated for hepatitis C in 2018/2019 and between 2014 and 2018, 86% of people with chronic infection started treatment. Outcome data are available for 86%; of these, 77% have been cured, 15% were lost to follow-up and 4% experienced treatment failure or viral rebound.

NHS England also reports that an increasing proportion of people being treated for hepatitis C are people who inject drugs and that referrals for treatment from drugs services increased in 2018/2019.

New hepatitis C infections have not fallen since 2011 and the WHO target of reducing new infections by 30% by 2020 is unlikely to be met in England, Public Health England reports.

There has been no reduction in sharing of injecting equipment since 2019 – 39% of respondents to the 2018 Unlinked Anonymised Monitoring survey of people who inject drugs said that they had recently shared some form of injecting equipment (including mixing containers or filters).

One third of people who inject drugs said that they had not been able to get enough sterile needles or syringes in 2018. Public Health England says that commissioners of services for people who inject drugs need to make sure that people who inject drugs have access to adequate harm reduction services.