Hepatitis Scotland e-Bulletin 10

Welcome to the next edition of Hepatitis Scotland's eBulletin.

England sees 25% rise in Liver Disease Deaths


 The first ever national report on statistics published by the National End of Life Care Intelligence Network has shown a 25% increase in liver disease death between 2001 and 2009 in England. This is in contrast with other major causes of death, which have been declining.  

A striking 90% of people who die from Liver disease are under 70 years old.  More than 1 in 10 deaths of people in their 40 are from liver disease. Professor Martin Lombard, National Clinical Director for Liver Disease, said "The key drivers for increasing numbers of deaths from liver disease are all preventable, such as alcohol, obesity, hepatitis C and hepatitis B. We must focus our efforts and tackle this problem sooner rather than later."


Mild ALT? What about Hep C?


Research from Holland, published in this months’ British Journal of General Practise, has urged GPs to test for hepatitis C in patients presenting with mildly raised ALT (alanine aminotransferase).

Mild alanine aminotransferase (ALT) elevations (30–100 IU/l) are commonly found in Primary Care.

This study demonstrated that HCV prevalence was ten times the usual population prevalence in Dutch primary care patients with an ALT level of 50 to 100 IU/l.


The authors suggest that routine follow-up for testing HCV in these patients is indicated.

There was not any elevated prevalence of Hepatitis B related to this range of increased ALTs. 

Hepatitis C Infections Increasing in young Americans

Surveillance data recorded between 2003 and 2010 in Pennsylvania has shown an increased incidence of new hepatitis C infections amongst adolescents and young adults. During this 7 year period, cases of hepatitis C amongst 15-34 year olds in Pennsylvania have almost doubled.  


A rise in incidence amongst young people has also been noted in other areas of the United States.

The increases in cases of hepatitis C among adolescents and young adults in this study were greater in rural areas, compared with two large urban centers.


Although it was pointed out that these findings almost certainly underestimate the real impact of viral hepatitis because it only takes into account those with access to testing, they should be interpreted with caution because of the small population in rural counties.

Sourced from Bikyamasr

England follows Scotland in approving new Protease Inhibitors

The National Institute for Clinical Excellence (NICE) in England and Wales has now recommended Victrelis (Boceprevir) and Incivo (Telaprevir) for NHS use in treatment for hepatitis C in its’ final draft guidance.   


Both drugs were approved by the Scottish Medicines Consortium (SMC) for use by the NHS in Scotland in late 2011.

Egyptians develop faster and cheaper hepatitis C test

In response to current Hepatitis C rates in Egypt, a research team from the American University in Cairo has developed an innovative liquid chemistry test which diagnoses hepatitis C using n.gold nanoparticles. The test can take less than an hour. 


It is also potentially considerably cheaper than traditional testing and doesn’t require any sophisticated equipment and therefore could offer significantly greater access to testing by the wider public. 

 New treatment for hepatitis B?

Arrowhead pharmaceuticals have produced a White Paper on research into using small interfering RNA (siRNA) therapeutics to treat hepatitis B.

Hepatitis Community must learn HIV Lessons


Last month Charles Gore, President of the World Hepatitis Alliance, used the conference of the Asia Pacific Association for the Study of the Liver in Taiwan to emphasise the importance of advocacy and surveillance in tackling global viral hepatitis, saying that those in the viral hepatitis community should learn lessons from the HIV community in terms of generating a political response to the disease.

HIV expert David Thomas, Chief of Infectious Diseases at the John Hopkins School of Medicine in Baltimore, echoed the point saying that the political response to hepatitis B and C lagged far behind that of HIV and that surveillance and diagnosis of viral hepatitis remained “woefully under resourced.”
Mr Gore also highlighted an ongoing ignorance and lack of awareness of the prevalence and huge worldwide death toll of viral hepatitis saying that “The inexplicable neglect of viral hepatitis is going to stop.”

 Index Predicts a Response

Research presented at the 19th Conference on Retroviruses and Opportunistic Infections in Seattle has shown that a modification of the Prometheus Index reliably estimates the likelihood of a hepatitis C monoinfected patient achieving a Sustained Virologic Response (SVR). 


According to Dr. Jose Medrano, a clinical investigator at the Hospital Carlos III in Madrid, the modification still needs further validation. 


However, ultimately it is hoped that it could be beneficial in helping clinicians and patients decide whether to start anti-viral treatment or whether to wait for new treatments and therapies if there is little chance of achieving SVR.

Greek Tragedy Shows Importance of Needle Exchange

The effects of crippling austerity measures in Greece are showing their impact on public health  with news that HIV transmission among IV drug users soared in 2011.  Central Athens has been worse affected, with a 1,250% rise in incidence in the first 10 months of 2011. 


Medecins Sans Frontiers say the extraodinary increase can be mainly attributed to the suspension or cancellation of needle exchange programmes. 


The stark HIV figures from Greece illustrate the impact that lack of access to harm reduction services can have on injecting drug users health.


A previous bulletin story highlighted studies  evidencing that needle exchange programmes, when combined with opioid replacement programmes, have prevented many hepatitis C infections in the UK.

In the United States, the politics and science of needle exchange services continue to collide following the re-instatement of a Federal Ban on funding of needle exchange programmes. 


The rise in HCV incidence amongst the younger population may change the terms of the debate there.

With the release in England of the new drug strategy “Putting Full Recovery First” and the decrease on emphasis on harm reduction e.g. The payment by results approach will encourage providers to supply services that achieve a set of defined and measurable outcomes that include being free of their drug of dependence and notUpdate involved in crime and in employment, it is important to consider the impact that substitute prescribing and needle exchange have had on mitigating the prevalence of BBVs.

Although the focus on holistic care is welcome and needed, it should be alongside of, not instead of, harm reduction programs.


As highlighted recently by Marcus Roberts, Director of policy at Drugscope “A fundamental principle for the recovery movement in mental health is that living better should not be conditional on getting better”.

Bulletin Opportunities

The Hepatitis Scotland e-Bulletin can be an opportunity to share views, experiences, and knowledge through our Scotland and sector-wide contact list, with the potential to enhance and enrich understanding on a diverse range of issues.


If you have any successful projects, local research or insights about other recent research, innovative ideas, local events or would simply like to express your views, why not put pen to paper (or fingers to keyboard) and forward it to us at leon@hepatitisscotland.org.uk and we’ll consider it for inclusion in the e-Bulletin.


Hepatitis Scotland
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