Hepatitisdoc.mediaplanet.com/all_projects/1733.pdf · Symptoms, testing and treatments for hepatitis B 6 Hepatitis B: The vital statistics 7 Oral antiviral treatment of hepatitis

HEPATITISA SPECIAL REPORT ABOUT THE EFFECTS OF A SILENT KILLER

AN INDEPENDENT SUPPLEMENT FROM MEDIAPLANET ABOUT HEPATITIS,DISTRIBUTED WITHIN THE TIMES

DECEMBER 4 2006

Advice you can depend on…

The British Liver Trust is a registered charity that aims to help everyone affected by liver disease through information, support and research.

We make every effort to make sure any advice you receive from our Helpline, website andleaflets is accurate, up-to-date and explained in language that is easy to understand.

Our medical content is provided by leading hepatologists and reviewed by people withpersonal experience of liver disease so that what we say reflects common patient experiencein the UK today.

You can take our word for it.

Fighting liver diseaseCall our Helpline0870 770 8028

or visitwww.britishlivertrust.org.uk

Like to [email protected]

AN INDEPENDENT SUPPLEMENT FROM MEDIAPLANET ABOUT HEPATITIS,DISTRIBUTED IN THE TIMES2

Welcome from theBritish Liver TrustThe UK is experiencing a dramatic increase in the incidence of liverdisease. A substantial proportion of this relates to viral hepatitis. Thegrowth of viral hepatitis, along with the ‘epidemic’ of alcohol-relatedliver disease and the rising tide of obesity present a significant triplewhammy to the liver.

The British Liver Trust, the national charity foradults with liver disease, believes that there is

a pressing need to recognise and address the conse-quences of doing nothing about this major publichealth issue.

Viral hepatitis in all its forms is an insidious dis-ease. It has few definable symptoms but can havedevastating physical and psychological effects. Forthe thousands of people infected with hepatitis andliving day-to-day with chronic hepatitis it can beisolating and utterly disruptive. Careers can behalted, loved ones put at risk and serious and life-threatening liver disease can occur.

StigmatiesdAt the British Liver Trust we regularly hear storiesfrom people who feel stigmatised and have been leftwithout support, information and even withouteffective treatment. Diagnosis has often come aftermany years of ill-health and sometimes too late,with the onset of cirrhosis and even liver cancer cur-tailing their lives, often unnecessarily.

EndorseThe British Liver Trust is delighted to endorse thissupplement which it views as an important contri-bution to raising the public profile of a little under-stood and poorly recognised range of diseases. Tosay that hepatitis and particularly hepatitis B and Cpresent a greater threat than HIV/Aids in the UKwould be an understatement. In an effort to convey

the message to the wider public, the Trust ismounting a campaign later this year aimed at thoseputting themselves at risk of hepatitis B infectionwhen travelling to high risk holiday locations. Its‘Think B-Fore You Go’ Day on 27th Decemberhighlights the need for awareness and precautionsincluding having the hepatitis B vaccination.

The Trust has also recently set up an online sup-port forum for people with hepatitis B. We are reg-ularly contacted by a growing number of peoplefrom all over the country enquiring about hepatitisB support groups. This forum will help to over-come the geographical distance between them. Ifpeople with hepatitis B are feeling isolated, wor-ried, confused or have unanswered questions abouttheir condition, the Trust is urging them to use thisforum to share experiences and support each other.

For those already with hepatitis B (an estimated180,000 but many more have not been diagnosed)

� Alison Rogers, Chief Executive of the British Liver Trust

and C (it is thought up to 750,000 are infected) theprogress in developing new and more effectivetreatments is vital. There is still no vaccine againsthepatitis C and the availability of the hepatitis Bvaccine is restricted in the UK to high-risk groups;implementation of a targeted programme, evenamongst those most at risk, is poor.

ProblemsThe articles in this supplement highlight the prob-lems that living with hepatitis brings and the pre-cautions that can be taken to prevent it. It looks atwork that is being done to improve treatment forpeople with these very complex diseases. Perhaps itcan also bring hope to those just diagnosed thatefforts are being made to make their lives better andthat greater awareness will prevent others having tolive through the same experiences.

CONTENTS

Hepatitis A: how, where, when and prevention 4

Advice you can depend on 5

Symptoms, testing and treatments for hepatitis B 6

Hepatitis B: The vital statistics 7

Oral antiviral treatment of hepatitis B 8

UK status of hepatitis B 8

Gilead Sciences 9

Know your Bs and Cs 10

Weighing the hepatitis C statistics 10

Support from The Hepatitis C Trust 11

The ‘silent killer’ is in the UK 12

Getting the elusive disease 13

Living with hepatitis C: two people’s experiences 14

Natural history of hepatitis B 14

Your liver, your life 14

Hepatitis B and C: invisible killers 15

HEPATITIS A TITLE FROM MEDIAPLANET.

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ABOUT THE BRITISH LIVER TRUST

The British Liver Trust is a national charity and was set up in 1988 to represent all adults with liver dis-ease. It works closely with patients, hepatologists and gastroenterologists through its support groupsand Medical Advisory Committee. Its work on hepatitis is only limited by its resources and sadly itremains a small and frighteningly under-funded organisation with a massive amount of work to do.

Please visit the Trust website at www.britishlivertrust.org.uk or call its Medical Helpline on 0870 7708028 for any information regarding hepatitis or any liver disease.

Mediaplanet in association with

ALL ARTICLES IN PREVIOUS MEDIAPLANET PUBLICATIONS ARE EASY ACCESSIBLE ON WW.MEDIAPLANETONLINE.COM

MEDIAPLANET ONLINE

Ellen KickBristol-Myers Squibb Senior research investigator

EA/1006/1057/0908 Date of preparation: November 2006

www.b-ms.co.uk LOPQ Pharmaceuticals Limited

In just over three years, Bristol-Myers Squibb has introduced several majormedicines in many markets around the globe to treat serious disease areas: a therapy to help treat HIV, a treatment for hepatitis B, and a medication forsevere mental illness. Our commitment to the research and development ofnovel compounds for serious diseases continues with a robust pipeline of investigational medicines in development.

Bristol-Myers Squibb is focussed on the world’s most serious diseases. We’ve never been more committed to our mission.

Today and tomorrow.


Hepatitis A, sometimes known ashep A or HAV, is a liver disease

caused by the hepatitis A virus. It ispassed from person to person by eatingfood or drinking water contaminatedwith the virus.

Fruit, vegetables and uncooked foodwashed in contaminated water can causeinfection, especially in hot countries.Shellfish can also be infected if it comesfrom sea contaminated with sewage.Food that has been cooked properly issafe, but it can become contaminated ifsomeone with the virus has handled it.

Hepatitis A is more common in coun-tries where water supplies and sewagedisposal is of a poor standard and wherehygiene standards and sanitation arelow. High-risk areas include Southernand Eastern Europe, Africa and parts ofthe Middle and Far East.

There are no symptoms for 2–6 weeksafter the virus enters the body. For somethe symptoms are so mild they may noteven realise they are infected yet theywill be able to pass on the virus to oth-ers. Others may experience symptomssuch as tiredness, aches and pains, fever,nausea, stomach ache and loss ofappetite. These symptoms last for aweek or more and then jaundice maydevelop. This makes the whites of theeyes and in more serious cases, the skin,turn yellow.

Jaundice is caused by the build up ofa yellow substance called billirubin.This is a waste product that the livernormally gets rid of but if the liver is

not working properly bilirubin buildsup in the body.

As with most viral infections there isno specific treatment. Most people feelbetter within a few weeks but may feeltired for several months. Hepatitis Awill not reoccur once the person has hadit and unlike the other hepatitis virusesthere is no long-term liver damage.

However the illness tends to be moreserious in older people and on rare occa-sions can cause fatal liver damage. Forthose who develop severe hepatitis A, aliver transplant is the only option tosave their life.

“Avoid having icecubes in drinks, drinking

tap water or eating ice-cream in countrieswhere hepatitis A is

common.”Fortunately there are steps that can betaken to prevent being infected withhepatitis A. The British Liver Trustadvises:

Get vaccinated – especially if travel-ling to a high-risk area. Vaccination isalso recommended for injecting drugusers, gay men [as certain sexual behav-iours may put individuals at risk], thosewho are at risk through their jobs egsewage workers, those who have long-term liver disease already as subsequent

infection with hepatitis A can cause amore serious illness.

You should try to avoid having icecubes in drinks, drinking tap water oreating ice-cream in countries wherehepatitis A is common.

ShellfishDon’t eat poorly cooked shellfish,uncooked vegetables, salads, unpeeledfruit or unpasteurised milk in high-riskcountries. Consultant Hepatologist at

St Mary’s Hospital, London, and a mem-ber of the British Liver Trust’s MedicalAdvisory Committee, Dr Mark Thurszexplains, “The hepatitis A virus[HAV] used to be quite common in theUK where people were infected duringearly childhood. This meant that theybuilt up antibodies against the virusmaking them immune for the rest oftheir life. As the prevalence of HAVhas declined so have people’s antibodies,therefore it is essential to get the hepati-

tis A vaccine before travelling abroad tohigh-risk areas. Unfortunately, con-tracting hepatitis A in adulthood ismuch worse than in childhood and canresult in liver failure and even a livertransplantation.”

For more information on hepatitisA, call the British Liver Trust

Helpline on 0870 770 8028 or visitthe website at

www.britishlivertrust.org.uk

Hepatitis A: how, where, when and preventionThe hepatitis A virus was a common childhood infec-tion in the early 20th century but is now relativelyunusual in the UK. Because the symptoms are fairlygeneral it is possible that more people have had itwithout even realising it.BY EMMA BOWLER

The company is focused on the dis-covery and development of inno-

vative treatments for serious unmetmedical needs such as cancer, cardio-vascular and metabolic diseases, hepa-titis, HIV/AIDS, psychiatric disordersand rheumatoid arthritis.

Chronic hepatitis B is a potentiallylife-threatening disease and a globalpublic health issue. The hepatitis Bvirus is thought to be 100 times moreinfectious than HIV and it is estimat-ed that more than 350 million peopleworldwide have chronic, lifelong,hepatitis B infection. In Europe, anestimated 1 million people are infect-ed with hepatitis B every year.

Measuring the amount of the hepa-titis B virus in a person’s bloodstream

— also known as the viral load — canhelp to predict a person’s progressionto serious liver disease and liver can-cer. Recent studies suggest thatamong hepatitis B patients who havethe highest viral load levels, there is asignificantly increased future risk ofeventually developing cirrhosis andliver cancer.

Earlier this year, the companyreceived approval to market a newmedicine for treating hepatitis B.Baraclude, also known as entecavir, isan oral antiviral therapy specificallydesigned to block the replication of

hepatitis B virus. The medicine,which was discovered and developedin Bristol-Myers Squibb research cen-tres, was approved by the EuropeanCommission in June 2006 and waslaunched in the UK soon after.

Bristol-Myers Squibb: committed to the researchand development of medicine for hepatitis

Bristol Myers Squibb’s mission is to extend andenhance human life by providing the highest qualitypharmaceutical and related healthcare products.

HEPATITIS AT A GLANCE

• Hepatitis means inflammation of the liver. The liver has more than 500 functionsvital for life including fighting infection, making bile to breakdown food in the gut,destroying and dealing with poisons and drugs, filtering and cleaning the blood.

• Inflammation of the liver can be caused by excessive alcohol intake or the sideeffects of some drugs, both illegal and prescribed. However, the most commoncause of hepatitis is viral infection.

• There are several different types of hepatitis virus, the main ones being hepatitisA, B, C, D and E.

• All of the viruses can cause an acute disease with symptoms such as jaundice,extreme fatigue, nausea and abdominal pain.

• The hepatitis viruses differ in the way they are passed from person to person, theway they cause liver damage and the effects they can have on the person’s health.

• Hepatitis A, B and C are the most common forms found in the UK.

• Most people recover from hepatitis A with no lasting liver damage but hepatitis Band C can cause long term liver disease, leading to cirrhosis and even liver cancer.In many cases there are no early warning symptoms until liver damage is faradvanced.

Seafood can be infected if it comes from sea contaminated with sewage.

Founded in 2003 by liver disease specialist Pro-fessor William Rosenberg, iQur is based in the

University of Southampton with operations acrossthe UK and Europe.

Putting Patients FirstiQur offers a comprehensive sample testing servicefor diagnostic and research use for hepatitis B,hepatitis C and HIV. The company’s proprietarytest, iQur FASTTEST, delivers accurate, reliableresults to clinicians, typically within 24–48 hours,enabling them to give the best possible service totheir patients.

Director of Operations, Di Sheridan explains,“Customer service is paramount and our Diagnosticdivision pays close attention to the individual needsof our clients. Our tests are available singly or incombination, and we have introduced the use ofblood spots or saliva samples for easier collection.Results are available in a variety of formats, includ-ing via fax, e-mail or letter.”

iQur has recently launched a new non-invasivemethod of assessing liver fibrosis. Using serummarkers, the Enhanced Liver Fibrosis (ELF) Testprovides valuable information to clinicians in thediagnosis, prognosis and treatment decisions forall diseases of the liver. “This simple blood test canbe used repeatedly, with minimal patient discom-fort, to monitor disease progression and responseto therapy,” says Sheridan.

Pushing BoundariesiQur has a number of strategies for the develop-ment of new therapeutics for liver disease. Thecompany aims for a holistic approach, attemptingto treat liver damage and using the immune sys-tem to attack hepatitis viruses. Chief ScientificOfficer, William Rosenberg explains, “As the liverbecomes damaged, it lays down scar tissue and thisfibrosis limits its function and causes damage. Wehave evidence that this process can be inhibited ata molecular level, which may offer a route to effec-tive new therapies.”

Currently, no vaccine exists for hepatitis C andthose that are available for hepatitis A and B havelimited efficacy. The failure to generate a protec-tive immune response for hepatitis C is attributedto failure in education of the immune system toeliminate the hepatitis C virus.

“Using serum markers, theEnhanced Liver Fibrosis (ELF)

Test provides valuable information to clinicians in the

diagnosis, prognosis and treatment decisions for all dis-

eases of the liver”“iQur uses a system that alerts the immune systemto fragments of the virus in an “immunogenic”context,” reveals Rosenberg, “thereby training itto eradicate infection. This effectively providesthe immune system with a strong signal that

allows it to learn how to deal with the virus. Thesystem is currently in pre-clinical development,but shows significant promise.”

The company also strives to improve drug treat-ment regimens currently used for liver disease.Existing drugs used for treatment of hepatitis Chave a severe limitation caused by the side effect ofanaemia and, although increased doses of drug aremore effective at killing the virus, these amountscannot be given to patients because of the anaemiathey induce. iQur is developing a range of newchemical entities (NCE’s) which have been shownto have significant anti-viral activity without thisside effect.

Further information on business develop-ment, partnering opportunities and iQur’s

range of services can be found atwww.iqur.com or by e-mailing [email protected]

iQur: the liver experts – diagnostics, therapeutics, knowledgeiQur Ltd is a specialty pharmaceutical company at the forefront of international breakthroughs in the detection, treatment and monitoring of viral hepatitis and other liver diseases.

AN INDEPENDENT SUPPLEMENT FROM MEDIAPLANET ABOUT HEPATITIS,DISTRIBUTED IN THE TIMES 5

Clarification of any medical issue,when it is required, is obtained

from the Trust’s Medical AdvisoryCouncil. All leaflets are also reviewed bymembers of the public who may havepresent or past experience of the subjectmatter.

AccurateThis is to ensure that information isaccurate and up to date in the firstinstance and, in the second, to makesure the information is conveyed inaccessible language and does not makeassumptions or omissions about treat-ment. This ‘lay review’ process ensuresthat information given accords withpatient experience, even taking intoaccount the variable nature of hospitalsettings.

The British Liver Trust had foundthat it is information about hepatitisthat is most frequently sought from thepublic. People diagnosed with hepatitis

require accurate and wide-rangingadvice about the disease to help themdeal not only with the physical effectsbut with the fear, confusion, distress andstigma that they, and those closest tothem, may experience.

Advice about hepatitis from the Trustis accessed not only in English butacross a range of foreign languages.Almost 10,000 people visit the Trust’swebsite looking for hepatitis adviceeach month; a significant proportion ofdownloads from these pages is informa-tion translated into Chinese, Hindu,Urdu and Bengali. The British LiverTrust is currently working on expand-ing this range.

Yet it is not only the public whorequire information about hepatitis.Knowledge of the disease amongst thewider medical profession in the UK isthought to be very poor.

To address this, the British LiverTrust is publishing two ‘professional’

guides to hepatitis B and hepatitis Cthis month. Written by leading clinicalexperts, they have been formulated foruse in non-specialist medical environ-ments. They are aimed at not only byGPs and nurses but at drug workers,

health and safety advisors or others insimilar occupations who are likely to berequired to assist in this area.

The publications provide a short,accessible guide to diagnosis, treatmentand prevention in order improve aware-

ness and management of these complexblood-borne viruses.

For more information call theBritish Liver Trust on

0870 770 8028 or visit www.britishlivertrust.org.uk

Advice you can depend onThe British Liver Trust has been producing patientinformation leaflets covering a variety of liver-relateddisease for many years. All publications are either writ-ten by or go through a peer review process by leadinghepatologists.


It takes one to six months after becom-ing infected with the hepatitis B

virus for any symptoms to emerge.Many people who are infected neverhave any symptoms; others develop amild illness but don’t feel unwellenough to see a doctor, but they can stillpass on the virus.

Acute hepatitis B Those with acute hepatitis B usuallyget better within a few weeks or atmost a few months. Of these a minori-ty develop severe acute hepatitis Bwhere only a liver transplant may savetheir life.

“A number of peoplewith chronic hepatitis Bmay carry the virus with-

out experiencing anysymptoms however they

are still carriers”General symptoms include tiredness,aches and pains, loss of appetite; individ-uals may also be sick, have stomach ache,dark urine, pale bowel motions andjaundice. Approximately 30 to 50 percent of those infected will develop jaun-dice where the whites of the eyes go yel-low and in serious cases the skin turnsyellow too. This occurs because of abuild up of a yellow substance calledbilirubin. The liver normally gets rid ofbilirubin but when it is not workingproperly bilirubin builds up in the body.

Hepatitis B becomes chronic whenthe infection lasts more than sixmonths. A number of people withchronic hepatitis B may carry the viruswithout experiencing any symptomshowever they are still carriers. Of thesesome will develop some degree of liverdisease. Approximately 25 per cent ofcarriers develop serious liver diseasesuch as chronic hepatitis, cirrhosis and,after many years, may develop livercancer.

Cirrhosis and liver cancerIf the liver is damaged for a short time itis able to regenerate to its original size.But when the liver is inflamed over along period of time it cannot regrowproperly, smooth liver tissue is replacedby much harder tissue and scarring,fibrosis, and this is known as cirrhosis.

An estimated 15 to 20 per cent ofpatients with chronic hepatitis B

acquired in adulthood develop cirrhosis.For those that develop life threateningcomplications as a result of cirrhosis aliver transplant is an option. This is suc-cessful in 60 to 80 per cent of peoplewho are very ill, though the hepatitis Bvirus does infect the new liver and canlead to liver disease again.

Advanced cirrhosis may also lead toliver cancer. A liver transplant can alsobe carried out if someone develops pri-mary liver cancer so long as the cancerhas not progressed too far. But generallyliver cancer is almost always fatal.

TestingHepatitis B can be detected by a bloodtest which looks for antibodies to thehepatitis B virus as well as proteins pro-duced by the virus.

Other blood tests known as Liver

Function tests (LFTs) may be carried outto measure substances in the blood-stream to indicate whether or not theliver is damaged. But the only way toproperly assess the degree of liver dam-age is by taking a liver biopsy.

TreatmentMost people with acute hepatitis B donot require treatment as they do notdevelop long-term liver damage. Withplenty of rest they eventually recover.

Those with chronic hepatitis Bshould be seen by a hepatologist, a spe-cialist in liver disease, or a gastroen-terologist, specialist in digestive dis-ease, to monitor for liver damage anddetermine treatment.

Individuals who require treatmentcan self-administer an antiviral injec-

tion of interferon, three times a week.Interferon aims to prevent the virusfrom growing and causing further liverdamage. But response to interferon canvary, and about 15 per cent of patientsare unable to tolerate it due to its sideeffects.

There are also oral antiviral drugsavailable, such as Lamivudine and Ade-fovir, but there are ongoing problems aspatients may develop resistance to thedrugs they are given.

Symptoms, testing and treatments for hepatitis BHepatitis B is a potential killer. It can cause acute andchronic disease with a range of symptoms from tired-ness and fever to cirrhosis and liver cancer. But howdo you know you’ve got it and what can be done totreat it?BY EMMA BOWLER

Hepatitis B: James’s story

I didn’t actually have any symptoms;I just happened to go to an STD clinicwhere they had introduced screen-ing for hepatitis B. Coincidently Iexperienced some mild stomach dis-comfort, I went home and my mumsent me to bed with a whiskey, dur-ing the night the pain got worse. As aresult of that reaction I thought Ishould ring for the results of thetests I’d had and they told me I hadhepatitis B.


Over the years I’ve had Liver Func-tion tests, biopsies and ultrasound tomonitor my liver. I eventually devel-oped cirrhosis and then theythought I had cancer; I went toAddenbrooke Hospital where theyobserved I had 50 tumours in myliver.


I started off having to inject interferon; I tried it twice but it just didn’t work for me.I was later given a combination of Adefovir and Lamivudine which had a really pos-itive effect on my liver, I’d never felt so well. The doctors treating me had neverseen anything like it before and realised my liver was regenerating; it was like win-ter turning into spring.

Living with something like this is like living under a darkened cloud, you arenever sure whether that cold or that headache is just something you have or due toyour liver. It’s a psychological strain more than anything but at least now there ishope with the drugs that are available. At least now I can look forward to thefuture.


The Department of Health estimatesthat there are around 180,000 peo-

ple in the UK who have chronic hepati-tis B. There are signs that hepatitis Binfection is on the increase with an esti-mated 1,300 cases of symptomatic acute

hepatitis B each year and 7,700 newcases of chronic hepatitis B. Of thesenew chronic cases approximately 300people were infected within the UKwhile the rest are as a result of immigra-tion from high-risk areas.

The World Health Organisation saysthat hepatitis B is considered secondonly to tobacco as a human carcinogencausing 50 per cent of primary liver can-cers, the sixth most common form ofcancer. Following diagnosis of liver can-cer only 5-6 per cent of patients will sur-vive beyond 5 years. Of 600 to 700 livertransplants conducted in the UK eachyear about 5.5 per cent are for peoplewith hepatitis B virus associated liverdamage.

The hepatitis B virus is one hundredtimes more infectious than HIV and isthought to be able survive in driedblood in excess of a week. It is estimatedthat in one year 10–30 million peoplewill become infected with the hepatitisB virus, making it the most commonserious liver infection in the world.

Since 1982 there has been an effectivevaccine available to prevent hepatitis Binfection and although the vaccine willnot cure chronic hepatitis, it is 95 percent effective in preventing chronicinfections from developing.

According to the Health ProtectionAgency hepatitis B notifications, inEngland and Wales, increased from 487in 1992 to 1,151 in 2003 – a 135 percent increase.

Figures from the Office for NationalStatistics show that visits abroad by UKresidents rose by 4 per cent during the12 months ending September 2005,from 63.3 million to 65.9 million. TheInternational Passenger Survey, says vis-its abroad by UK residents to areas ofhigh risk for hepatitis B rose by 26 percent during the 12 months ending June2005.

Hepatitis B: The vital statisticsThe World Health Organisation estimates that of the 2billion people who have been infected with the hepati-tis B virus, more than 350 million people are chronic,lifelong, carriers of the virus. Of these over half a mil-lion to one million will die every year as a result ofchronic hepatitis B, cirrhosis and liver cancer. BY EMMA BOWLER

About NovartisNovartis AG (NYSE: NVS) is aworld leader in offering medicines toprotect health, treat disease andimprove well-being. Our goal is todiscover, develop and successfullymarket innovative products to treatpatients, ease suffering and enhancethe quality of life. Novartis is theonly company with leadership posi-tions in both patented and genericpharmaceuticals. We are strengthen-ing our medicine-based portfolio,which is focused on strategic growthplatforms in innovation-driven phar-maceuticals, high-quality and low-cost generics, human vaccines andleading self-medication OTC brands.In 2005, the Group’s businessesachieved net sales of USD 32.2 bil-

lion and net income of USD 6.1 bil-lion. Approximately USD 4.8 billionwas invested in R&D. Headquarteredin Basel, Switzerland; NovartisGroup companies employ approxi-mately 97,000 people and operate inover 140 countries around the world.

About Idenix Idenix Pharmaceuticals, Inc., head-quartered in Cambridge, MA, is abiopharmaceutical company engagedin the discovery, development andcommercialization of drugs for thetreatment of human viral and otherinfectious diseases. Idenix’s currentfocus is on the treatment of infectionscaused by hepatitis B virus, hepatitisC virus and human immunodeficien-cy virus (HIV).

Idenix/NovartiscollaborationNovartis and Idenix are working in collaborationunder development and commercializationarrangements established in May 2003, on varioustreatments for hepatitis C and hepatitis B. Underthe agreements, Novartis and Idenix will co-pro-mote in the United States, France, Germany, Italy,Spain and the United Kingdom. Novartis has theexclusive right to commercialize the developmentsin the rest of the world.

� In one year 10–30 million people willbecome infected with the hepatitis Bvirus

NEWS IN BRIEF

❧ Too many healthcare workers exposed to blood-borne viruses “Eye of the Needle”, a new report from

the Health Protection Agency shows that healthcare workersare still being exposed to bloodborne virus infections, eventhough such exposures are largely preventable. Elevenhealthcare workers were infected with hepatitis C via needlestick injuries in the last eight years; two of these incidentswere reported in the last 12 months.

The report shows that even though a lot has been done toprotect healthcare workers, the number of reported occupa-tional exposures has increased 49 per cent in three years,from 206 in 2002 to 306 in 2005. This rise could be due toincreased awareness of the risks of needlestick injuries or agenuine increase in the number of injuries, either way thereport highlights the need for NHS Trusts to provide localprotocols and information on the risk of bloodborne virusesin the work place and to ensure that healthcare workers areadequately trained on how to prevent injuries.

www.hpa.org.uk/infections/topics_az/bbv/s_report.htm

❧ Thousands more people with hepatitis C to bene-fit from latest NICE guidance on drug treatments

The National Institute for Health and Clinical Excellence(NICE) has recently issued guidance recommending the useof two drugs, peginterferon alfa and ribavirin, for the treat-ment of people with mild chronic hepatitis C within the NHS.

SymptomsRecent estimates suggest that approximately 200,000 to500,000 people are infected with hepatitis C in England andWales although only around 47,000 people have been diag-nosed and only around 7000 treated. Current practice is totreat only those patients with moderate or severe symptoms.

CombinationToday’s guidance however states that people with mildchronic hepatitis should also be offered combination therapy.Andrew Dillon, NICE Chief Executive and Executive Lead said,“We are recommending these drugs as the evidence suggeststhat treating patients with hepatitis C in its earlier stageswhen symptoms are milder can be effective at suppressingthe virus and delaying disease progression. Treatment inthese patients is also cost effective – for example early treat-ment might prevent the need for a costly and complicatedliver transplant at a later stage.”


The majority of people with acutehepatitis B do not need treatment

as they do not develop any long-termliver damage. However, for those whodevelop chronic hepatitis B, which iswhen the infection persists for morethan six months, treatment may be ben-eficial. The aim of treating those withchronic hepatitis B is to prevent infec-tion progressing towards the more seri-ous symptoms of cirrhosis, liver cancerand liver failure.

“About 15 per centof patients are unable totolerate interferon due toits side effects which mayinclude loss of appetite,

nausea, tiredness, depres-sion and cardiovascular

problems”Until recently regular interferoninjections were the mainstay of chronichepatitis B management. Interferon is agenetically engineered version of a pro-tein naturally produced by the body’simmune system when responding toviral infection.

Interferon alpha treatment is givenas three injections per week for four to

six months which can be inconvenientfor patients. The treatment stops viralreplication in only around 40 per centof patients, nevertheless liver biopsiesusually show a sustained improve-ment and patients are less likely todevelop serious liver disease and pos-sibly liver cancer.

However, about 15 per cent ofpatients are unable to tolerate interfer-on due to its side effects which mayinclude loss of appetite, nausea, tired-ness, depression and cardiovascularproblems. A newer form of interferonknown as ‘pegylated interferon’ whichrequires only once-weekly injection isnow available.

Fortunately, alternative oral antiviralmedication is now also available. Onesuch option is Lamivudine, this drug istaken orally, one tablet per day, forabout a year. Its aim is to reduce theamount of virus in the body by inhibit-ing viral production. Clinical trials haveshown Lamivudine to be effective andtolerated for therapy lasting three years.

Again this doesn’t work for everyoneand there is a problem with resistance.Around 26 per cent of patients developresistance to Lamivudine each year withup to 80 per cent of patients developingresistance after five years of treatment.

This problem heightens the need foralternative drug therapies or drug com-binations to be developed. Adefovir is a

new therapy which became available inthe UK in April 2003. Clinical trialslook promising indicating Adefovir canimprove the condition of liver tissue andreduces viral load. The benefits of thedrug seem to be sustained during long-term treatment and resistance to Ade-fovir has been shown to be relatively

rare. Several clinical trials have alsoshown Adefovir is effective againststrains of hepatitis B virus that areresistant to Lamivudine.

With an increasing array of effectivemedicines to combat hepatitis B infec-tion in development it seems likely thatcombination therapy will become the

treatment of choice for chronic hepatitisB patients in attempt to minimise therisk of drug resistance and ensure long-lasting effectiveness. However, the raceto find the ideal combination and dura-tion of treatment is currently unfin-ished, although the contenders seemlike they may be on the right track.

Oral antiviral treatment of hepatitis BThere are a growing number of treatment options forthose infected with the hepatitis B virus including oralantiviral treatments. But problems with side effectsand resistance mean it’s an ever-changing battlefieldagainst the virus.BY EMMA BOWLER

The British Liver Trust estimatesthat 1 in 1,000 people in the UK

have the hepatitis B virus. In someinner-city areas, where there is a highnumber of people from parts of theworld where the virus is common, asmany as 1 in 50 pregnant women maybe infected.

Steps have been taken to reduce thespread of the virus; all blood donationsin the UK are screened for hepatitis Band since April 2000, all pregnantwomen in the UK are tested for it. If themother is found to be infected the babyis given a course of injections of anti-bodies called immunoglobulin and vac-cinated immediately after birth.

But the number of individuals infect-ed by hepatitis B in the UK is rising.The Health Protection Agency esti-mates 4,400 new acute hepatitis B casesoccur every year together with 7,700new cases of chronic hepatitis B. Only300 of these 7,700 individuals wereinfected in this country, the rest, 96 percent, are immigrants to the UK.

Very little is known about this groupapart from the fact they are often fromareas of high risk for acquiring hepatitisB. Many will not present themselves tothe health system until they have overtsymptoms even though they will havebeen a carrier of the infection prior to this.

More research is needed to explorehow migration is contributing to thespread and prevalence of hepatitis B;one potential course of action is screen-ing as Professor Roger Williams, Foun-dation for Liver Research explains, “TheFoundation for Liver Research is push-ing for testing of individuals from highfrequency areas of the world as part ofthe visa application process. Thiswould not only help us ascertain thetrue frequency of new hepatitis B casescoming into the country but it wouldalso mean those who are infected canstart to receive proper treatment beforethe virus causes too much damage.”

The majority of new infections could

be prevented through vaccination.Worldwide over 150 countries haveimplemented universal vaccination ofnewborns and/or adolescents. But in theUK vaccination is only offered tohealthcare workers, babies of infectedmothers and selected high-risk groups.

“The Government’sargument is that the costdoesn’t merit the benefitbased on the frequency ofinfection in this country.

But this is now beingturned on its head”Professor Williams explains why the

economic argument against universal

vaccination is now floundering, “TheGovernment’s argument is that the costdoesn’t merit the benefit based on thefrequency of infection in this country.But this is now being turned on its headdue to the number of immigrants –legal and otherwise – coming in from,and the number of travellers and busi-ness people going out to, high-riskcountries. The argument no longermakes sense, what does make sense nowis to have a universal vaccination pro-gramme starting from birth to givesome protection from acquisition inlater life.”

The Foundation for Liver Researchreport “Out of the Shadows” estimatesthat acute and chronic hepatitis B couldcost the NHS between £26 million and£375 million. The lower figure is basedon an estimate of diagnosed patients,and includes hospital costs only; thehigher figure is based on all patientsbeing diagnosed and treated which iscurrently not the case.

Maybe now is the time to reevaluatethe argument against spending moneyon hepatitis B prevention, otherwise itcould prove to be a costly mistake toignore the old adage that “prevention isbetter than a cure”.

UK status of hepatitis BWhile the overall prevalence of hepatitis B in the UK isrelatively low, there are growing concerns that thepublic health risk from the virus is being virtuallyignored in spite of its increasing clinical and economicimpact.BY EMMA BOWLER

� All blood donations in the UK are routinely screened for hepatitis B


Gilead Sciences is a biopharmaceu-tical company that discovers,

develops and commercialises innova-tive therapeutic treatments in areas ofunmet medical need. The company’smission is to advance the care ofpatients suffering from life-threateningdiseases worldwide.

Headquartered in Foster City, Cali-fornia, Gilead has operations in NorthAmerica, Europe and Australia.Employing over 2,300 people world-wide the company maintains research,development and manufacturing facili-ties in the United States and Europe.

Gilead uses the most advanced scien-tific tools available to develop therapeu-tics for the treatment of infectious dis-eases. Based upon recent advances inmolecular and cellular biology,researchers understand viral replicationbetter than ever before. Gilead appliesthis knowledge to study the sites of viralreplication and to explore how a virusmight mutate to become resistant totreatments. This allows for a betterunderstanding of the profile of antiviralmedications - both alone and in combi-nation with other antivirals - and pro-vides physicians with insight intowhich therapeutics or combinationsmay produce optimal benefits.

Throughout the process of designingnovel antiviral therapeutics, Gileadbiologists and chemists work togetherto examine key viral enzymes that arerequired for the replication of pathogen-ic viruses in host cells. With theirdetailed understanding of the structureand function of these viral enzymes, ortargets, Gilead researchers aim to designand synthesize new antiviral inhibitorswith more favourable characteristics,such as enhanced potency, an improvedresistance profile, prolonged duration ofactivity and better selectivity.

The Impact of Viral HepatitisViral hepatitis remains an area of largeunmet medical need globally. Despitethe success of infant vaccination pro-grammes, approximately 80,000 peoplein the United States and one millionpeople in Europe are infected with hepa-titis B each year.

In addition, an estimated 170 millionpeople worldwide have chronic hepati-tis C, and the United States Centers forDisease Control and Prevention projectthat this number will triple over thenext two decades if an effective vaccineis not developed.

More than 20 per cent of people withchronic hepatitis B or C will developcirrhosis, liver cancer or liver failure.Gilead is engaging in research for novelcompounds for the treatment of hepati-tis B and C. In late 2004, Gilead signedagreements with Achillion Pharmaceu-ticals and Genelabs Technologies, Inc.that grant Gilead worldwide rights forthe research, development and commer-cialisation of certain small moleculeinhibitors of hepatitis C virus replica-tion. These programmes are highly com-plementary to Gilead’s own in-houseresearch programmes in hepatitis C.

In addition to developing medicinesthat improve the treatment of life-threatening infectious diseases such ashepatitis B, Gilead collaborates withpatient advocates and implements a

patient assistance programme to helpensure access for patients in need. Byproviding comprehensive support topatients, physicians and caregivers,Gilead strives to advance patient care.

Gilead Sciences

© 2006 Gilead Sciences, Inc.

Fighting life-threatening infectious diseases.

At Gilead, we are applying biopharmaceutical science to

create innovative medicines for the treatment of HIV,

hepatitis, influenza and serious fungal infections.

Aiming to improve current treatment standards.

Our aim is to develop new drugs with greater potencies,

improved resistance profiles, better safety indices and

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significantly advance patient care and improve human lives.

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Phone +44 (0) 20 8587 2200Fax +44 (0) 20 8622 3243

103/UKM/06-11/CM/87


There are differences in the mechan-ics and treatment of hepatitis B and

C these diseases, including transmis-sion, vaccines and symptoms.

The hepatitis B virus (HBV) is moreinfectious than the hepatitis C virus(HCV); not only is HBV spread byblood-to-blood contact, it is also foundin the body fluids of infected people:sweat, tears, breast milk and semen.HBV is up to 100 times more infectiousthan HIV in needle-stick injuries.

Hepatitis C differs from hepatitis Bin that it is an RNA virus. This meansthat it is able to mutate and change,making it very difficult to create a vac-cine. As a result while there is a vaccinefor hepatitis B, there is still no vaccinefor hepatitis C. Much is still beinglearnt about these diseases.

One of the major differences betweenthe two viruses is that by far the majori-ty of adults who contract hepatitis Bmanage to recover from it themselves

without any medication before itbecomes a chronic life-threatening con-dition. This is not true of hepatitis Cwhere about 80 per cent of infected peo-ple will develop the chronic condition.It is also not true of infants who contracthepatitis B at birth from their infectedmothers – they will develop chronicHBV.

Chronic hepatitis B is a devastatingdisease that can easily be preventedthrough vaccination but, unlike HCV,it cannot be cured.

Like hepatitis B, hepatitis C can sur-vive for a week or more outside the body.Symptoms in both can be non-specific,or take several months to appear.

Get testedMost importantly, both can be treatedeffectively, and in many cases of hepati-tis C, even cured. Being diagnosed soon-er rather than later makes all the differ-ence.

NEWS IN BRIEF

❧ Donate for life “Viral hepa-titis is overtaking alcoholic

cirrhosis as the commonest indica-tion for liver transplantation in theUK,” said Mr David Mayer, consult-

ant surgeon at Birmingham’sQueen Elizabeth Hospital and Chair

of the Liver Advisory Group to UKTransplant.

This is a major concern for UK sur-geons already facing a chronic

shortage of donated organs fortransplantation. In the last five

years more than 350 people havedied whilst waiting for a liver

transplant, 48 of whom sufferedwith the most common viral strain

of the disease – hepatitis C.The increased incidence of the

hepatitis has inevitably con-tributed to increased waiting timesand deaths on the liver transplant

waiting list. UK Transplantspokesman Noel Davies said: “Atransplant continues to be the

most effective treatment for liverfailure, with 66 per cent of trans-

planted livers still functioning wellfive years on. But the single

biggest obstacle to more livesbeing saved through transplants is

the fact that four out of 10 fami-lies currently refuse permission for

their loved one’s organs to bedonated.”

For further information, con-tact the Organ Donor Line on

0845 60 60 400 or visitwww.uktransplant.org.uk

❧ Research for the futureThe Foundation for Liver

Research, within the Institute ofHepatology, UCL, funds a researchgroup of twelve people dedicatedto the study of hepatitis B and C

infection. On the laboratory benchthe group are investigating the

processes by which the body,through its immune system, can

naturally clear the infecting virus,whether hepatitis B or C.

Another project carried out jointlywith the Nuffield Trust is mapping

cases of hepatitis B infectionaround the country in relation to

health service provision. A somewhat similar investigation

but in relation to chronic hepatitisC infection, which affects possibly

some 300,000 patients in thiscountry, is a new initiative of a

joint outreach drug abuse clinic incentral London with a primary

care trust. Over the first three months stafffrom the Institute of Hepatology

found the number of patientsdetected was more than threetimes the total number being

referred to the hospital over a year;this research should enable more

effective treatment of this suscep-tible group.

The Foundation for Liver Researchco-authored “Hepatitis B: Out ofthe Shadows – a Report into the

Impact of Hepatitis B on theNation’s Health” [2004].

Know your Bs and CsHepatitis put simply means inflammation of the liver.Hepatitis B and C both affect the liver in this way; theyare systematic viruses, both blood borne; unchecked,the disease leads to liver scarring which can cause cir-rhosis, liver cancer and even liver failure. BY KELLY CRUMMIE

Taking some lessons from theFrench, who have a similar infec-

tion rate to us, would be a smart move asthey have been leading the rest ofEurope in tackling hepatitis C.

Infection ratesThe Department of Health estimatedthat that about 250,000 in Englandpeople have been infected with hepatitisC. The Hepatitis C Trust believes thisfigure stands at 400,000 to 500,000,close to one in a hundred of the popula-tion and similar to the rate estimated bythe Scottish Executive for Scotland andthe rate in France and other mediumprevalence European countries (someSouthern European countries and theUS have considerably higher rates).

Detection ratesLess than 70,000 have ever been diag-nosed in the UK, many of whom willalready have died from their hepatitis C.

This means that of those now infected,only between 1 in 5 and 1 in 10 knowsit. And of course it’s the people whodon’t know it who are at most risk ofgetting cirrhosis or liver cancer. InFrance, after a really high profile aware-ness campaign, over half of all thoseinfected have been diagnosed

Treatment ratesOnce diagnosed, people can be offeredtreatment that can stop and oftenreverse the liver damage in 50 per centof those who take it. So how is the UKdoing here? The answer is not well. Ina report released by The Hepatitis CTrust to coincide with the 2005World Hepatitis Awareness Day, itstates that in 2004 only 2,600received treatment in the UK, com-pare with 12,700 in France. In otherwords ‘In France, six to 12 times asmany people diagnosed with hepatitisC are likely to receive treatment thanthose diagnosed in the UK.’

French comparisonsThe French Governments Hepatitis CAction Plan is working. Their detectionrate has more than doubled in the lastten years. The UK’s are improving com-pared to previous years – 2004 and 2005saw a significant increase in the numberof new cases identified, though even atthe current rate it will take more than50 years to diagnose all those currentlyinfected, let alone those infected in thefuture. Commenting, Charles Gore,CEO of The Hepatitis C Trust, said,“The action taken in France has beenextremely effective. We need to followtheir lead in taking a clearly planned,properly financed and well executedapproach to this disease.”

Awareness is keyIn France patient awareness is muchhigher than in Britain, 56 per cent ofthose know they are carrying the dis-ease; more than one in two. This is up tofour times higher than in the UK. If theUK can learn from France not only willour statistics improve but like Francewe will begin to witness a reduction indeaths from liver disease.

Weighing the hepatitis C statisticsUK statistics for hepatitis C do not make for comfort-able viewing. That said, it is crucial we absorb them andact on them. In doing so we will have to confront howdire the situation really is and take positive action tochange it around.BY KELLY CRUMMIE

� France has a similar infection rate tothe UK, but a far better record for treat-ment of hepatitis C


The Hepatitis C Trust Helpline is0870 200 1 200, calls are confiden-

tial and are charged at the national rate.It is open Monday to Friday from 12until 6pm (and till 7pm on Thursdays).We are a member of the TelephoneHelplines Association.

Support Groups These groups are agreat way of meeting others living with

the virus and can be a good way of hear-ing other people’s stories and strategiesfor how they cope with symptoms.Contact The Trust to find out aboutsupport groups they run in London andfor details of groups around the country.

Website The Hepatitis C Trust has avery large information website (visit

www.hepctrust.org.uk) which providesan invaluable resource for anyone livingwith hepatitis C. It is continuallyupdated and covers a wide range ofinformation and issues explained in aneasy to understand and sensitive way.There are sections on the hepatitis Cvirus, treatment, support, benefits,

travel, latest news, insurance, personalstories, a discussion forum and much,much more. They hold live questionand answer sessions with experts on thediscussion forum on a regular basis –including topics such as: Treatment,Insurance Issues, Traditional ChineseMedicine, Liver Transplants.

Support from The Hepatitis C TrustThe Hepatitis C Trust isdedicated to offeringmany types of support tothose people living withhepatitis C, and also tothose who are partners,friends or family of peo-ple with HCV. They pro-vide a friendly and infor-mal Helpline service, giv-ing information andemotional support. Thestaffs’ knowledge isextensive – all membersof the helpline team have,or have had hepatitis C.

NEWS IN BRIEF

❧ K1 helps to KO spread ofhepatitis The K1 syringe is

saving lives and preventing thespread of diseases Hepatitis, HIVand Aids. The auto-disable (AD)

syringes’ unique design wasinvented by Marc Koska OBE to

prevent needless loss of life. A common transmission of the

blood borne Hepatitis virus (andHIV/Aids), especially in developinghealthcare systems, is via the use

of syringes that are only supposedto be used once being reused onseveral different individuals. The

K1 syringe eliminates this possibili-ty as it is designed to be used only

the once. The syringe accomplishesthis by locking and self destructing

if refilling it is attempted. The World Health Organisation

(WHO) has approved the K1,which since its manufacturing

and distribution all over the worldhas helped save in excess of a mil-

lion lives.For more information go to

www.starsyringe.com.


Get tested was the mantra of thisyear’s WHAD – World Hepatitis

Awareness Day, held on October the 1st.This is the date assigned to raise theawareness of hepatitis C (and hepatitisB), and the devastating impact thatthese viruses have globally, by varioushepatitis patient associations over theworld.

On their agenda, aside from attempt-ing to raise awareness, they are demand-ing action from government bodies andorganisations with the powers torestrain and exert some control over thespread of prolific diseases; not only byeducating individuals, societies andinstitutions to take preventative meas-ures but also in building healthcareinfrastructure that is better equippedand financed to provide quicker, moreeffective treatment to those alreadyinfected.

It is estimated that up to 600 millionpeople are infected by the hepatitis virusworldwide. Approximately 180 millionof those have hepatitis C; viral hepatitisis, in some parts of the globe, of epidem-ic proportions1.

Complacency can be an easy veil tohide behind in terms of personal health;such huge figures surely indicate this isa problem elsewhere around the world,not here, not with us. Wrong.

According to The Hepatitis C Trust,the UK is currently losing the battleagainst hepatitis C. This is due in largeto ignorance. The fact is it is not knownexactly how many people in the UKhave the infection, because there hasbeen no proper survey. Estimates rangefrom the Department of Health’s con-servative approximation of 240,000 ofthe UK’s 60 million population infectedwith hepatitis C to the much higher fig-

ure of up to 600,000 given by NICE(the National Institute for Health andClinical Excellence). The Hepatitis CTrust believes the figure to be aroundthe 500,000 mark (or 0.8 per cent of thepopulation)2.

UK diagnosis figures over the yearshave remained static – this is notbecause the disease is under control, it isbecause patient awareness is so low, andpeople are not coming forward to betested. Awareness has to be raised notjust in the general public, but alsoamongst medical practitioners, so thatpeople who may have been at risk areconfidently identified and offered test-ing by their GPs. It is believed only onein ten of those infected with hepatitis Cactually has any knowledge they are car-rying the disease.3 Worryingly, this fig-ure is expected to increase, which willbe followed by a rise in cancer levels andcirrhosis of the liver, putting a tremen-dous strain on the already stretchedNational Health Service.

If warnings to raise higher awarenessof hepatitis are not heeded, individualswho remain unaware that they are infect-ed will potentially and unknowinglyinfect others. Furthermore, these peoplewill remain untreated and undiagnosedfor a disease that is treatable, however leftuntreated may lead to the slow disinte-gration of the health of their liver.

Markos Kyprinanou, EuropeanUnion (EU) Commissioner for Healthand Consumer Protection, at the WorldHepatitis Awareness Day 2006 said,“The vast majority of infected people donot know that they are infected with thehepatitis virus. Stigma and fear can suf-focate awareness. These barriers preventpeople from getting tested, gettingtreatment and clearing themselves ofthis disease.” Only by talking openlyabout the hepatitis C virus will the mis-conceptions about the ways hepatitis Cis transmitted and the infection con-tracted, stigmatisations be combated.

The ‘silent killer’ is in the UKHepatitis C has no vaccine, so education about preven-tion and the treatment options available are of para-mount priority, especially as hepatitis C can actually becured in some people.BY KELLY CRUMMIE

To the UK’s credit we are one ofonly four European countries (the oth-ers being France, the Netherlands andSweden) out of fifteen to have a nation-al plan to fight hepatitis, after a rec-ommendation was made by WHO (theWorld Health Organisation) in 1999.In a 2006 the European Liver PatientsAssociation (ELPA) commissioned asurvey of its member organisations, inthe UK these members are: TheBritish Liver Trust and The HepatitisC Trust.

(To see the full ELPA report on‘Health Care Access and Public Policyfor the Prevention and Care of ViralHepatitis in Europe’ go to the WorldHepatitis Awareness Day website)

SurveyAnother survey of Primary Care Trustsand NHS Hospital Trusts, carried outby The Hepatitis C Trust on behalf ofthe All-Party Parliamentary Hepatol-ogy Group (APPHG) (PCTs) they con-cluded, “The Department of Health’sHepatitis C Action Plan for England isnot working because it is not beingimplemented.” The APPHG Executivefurther predicted that, “Unless vastlymore vigorous efforts are made now at alocal level by PCTs, encouraged by tar-gets and a timetable set out nationallyby the Department of Health, we pre-dict that hepatitis C will in the futurebecome a crushing burden to our healthservice and that we will look back andknow that we could have prevented thathappening.”4

Charles Gore, Chief Executive of TheHepatitis C Trust commented, “Theharsh reality is that hepatitis C infectionis a serious public health problem thatthe UK is not equipped to address.”5

Alison Rogers of the British LiverTrust adds: ‘While there has been somegovernment effort put into raisingawareness of hepatitis C it has been arather toe in the water approach, com-pared to the millions of pounds spent onother health issues. Britain is still waybelow other European countries in diag-nosis and treatment.’

1 The UK vs. Europe: Losing the fightagainst hepatitis C. The Hepatitis C Trust.

October 20052 Hepatitis C Fact Sheet. The Hepatitis C

Trust. 1 February 2006 3 Hepatitis C Fact Sheet. The Hepatitis C

Trust. 1 February 2006 4 A Matter of Change. An audit of hepatitis

C healthcare in England. APPHG. May2006.

5 The UK vs. Europe: Losing the fightagainst hepatitis C. The Hepatitis C Trust.

October 2005.

ELPA survey questions asked UK’s response (negative/positive)

Comparison/comment(The commentary is independent, these are nottaken from or the opinion of the ELPA report)

Is there a national plan to fight hepatitis? Positive The UK was one of only four of the fifteen coun-tries questioned to answer positively to this.Although, there is a big question mark over howeffective the Action Plan for Hepatitis C actually is.

Is there public funding of patient associationsfor their funding?

Positive Patient organisations, like the British Liver Trustand The Hepatitis C Trust are incredibly impor-tant and must be included at all stages of devel-opment and implementation for an effectiveAction Plan for Hepatitis C.

Are screening campaigns organised by the Gov-ernment?Are screening campaigns held annually?

Negative to both Only France and the Netherlands had screeningcampaigns organised by their Governments andonly Austria has an annual screening campaignwhich is privately funded. Such programmes areneeded to gain a truer picture of the extent ofthe problem of Hepatitis C; running high profileannual media awareness campaigns aimed atanyone of risk would be likely to have a pro-found effect on detection and treatment rates.

Is there easy access to screening?Is testing free?Is testing anonymous?Can a patient be screened by his GP?Can the patient be screened by his specialist?

Positive to all The UK was one of only three out of fifteen toanswer positively for all of the questions; alongside were France and the Netherlands. In the UKit is usually possible to get screening with someGPs, Sexual Health clinics of GUM department,Drug Dependency Units and Community DrugTeams, One Stop Health Shops and if you are apregnant woman it is possible to be tested at anAntenatal Clinic.

In the following table is a selection of some of the questionsasked by the ELPA survey, whether the UK’s response was posi-

tive or negative and how it compared with the other Europeancountries surveyed:

Source: ELPA report on ‘Health Care Access and Public Policy for the Prevention and Care of Viral Hepatitis in Europe’ go to thewww.worldhepatitisawarenessday.com

ELPA SURVEY

FOR FURTHER INFO ON HEPATITIS C GO TO:

www.britishlivertrust.org.ukwww.hepctrust.org.ukwww.who.intwww.worldhepatitisawarenessday.org


Many people with the virus experi-ence no symptoms, some have a

few and some have many. It is a veryindividual disease with no definite setpattern of symptoms or disease progres-sion.

Testing proceduresIf you decide to go for a test, it can berelatively easy to arrange one. Althoughthe number of places available to dotesting will vary regionally, nationwidethere are GUM and sexual health clinicsthat provide hepatitis C testing. GPswill usually supply this service too, but

this varies from practice to practice.Diagnosis for hepatitis C is obtained

by testing your blood for the presence ofantibodies first. A positive result meansthat the body’s immune system has pro-duced antibodies in response to expo-sure to the virus but does not necessarilymean the virus is still in your body. Toestablish that the virus is still present inthe body a further blood test known as aPCR or viral RNA test is carried out.

Once you receive a positive PCR testyou will then have further tests to findout which ‘genotype’ or strain of thevirus you have (these are subtypes num-

bered 1-4), and the condition of yourliver amongst others.

TreatmentDrug treatment to eradicate the virushas advanced greatly in the last fewyears with success rates now around 50per cent for genotype 1 and 80 per centfor genotypes 2 and 3. These are themost genotypes most common in theUK. However, the treatment can havesignificant side effects and is not suit-able for everyone. Even if treatmentdoes not work it can help to slow downthe progression of liver damage.

“Diagnosis for hepatitis C is obtained bytesting your blood for the

presence of antibodiesfirst. A positive resultmeans that the body’simmune system has

produced antibodies inresponse to exposure to

the virus”Patients diagnosed with hepatitis Care offered the combination therapy ofpegylated interferon alpha and rib-avirin. It is effective in clearing the virusin around 50 per cent of people overalland 80 per cent in those with specificgenotypes (2 or 3).

New treatmentThree months ago the National Insti-tute for Health and Clinical Excellence(NICE) delivered new guidance recom-mending that everyone with the viruswas now eligible for treatment. Previ-ously you had to wait until you had atleast moderate liver damage beforebeing eligible. Chief Executive andExecutive Lead at NICE, Andrew Dillon

explained that by treating patients withthis combined drug therapy “whensymptoms are milder it can be effective atsuppressing the virus and delaying dis-ease progression.”

He went on to point out the advantageof the treatment being “cost effective –for example early treatment might pre-vent the need for a costly and complicat-ed liver transplant at a later stage.”Suchguidance needs to be implemented

quickly throughout the NHS stressedCharles Gore, Chief Executive of theHepatitis C Trust, calling “on all thoseinvolved to ensure patients are offeredthe opportunity to benefit from thesetreatments as soon as possible.” [NICE2006/ 040]

With this standard of current carebecoming the norm, it is possible for50-90 per cent of patients with hepatitisC to be cured.

Getting the elusive diseaseOne of the reasons why hepatitis C remains undiag-nosed is because the symptoms can be non-specificand easy to put down to something else. For example,depression, fatigue, skin problems, insomnia, pain,joint problems and digestive disorders are all symp-toms of the virus but could all have other causes. BY KELLY CRUMMIE

� The number of places available for hepatitis testing will vary regionally

NEWS IN BRIEF

❧ Snorting drugs and hepatitis C It’s a popular missconception that the correlation between hepatitis C

virus (HCV) and drug use only applies to the shared use ofneedles. New research shows that those partaking inintranasal drug use (snorting drugs, like cocaine which isparticularly corrosive, through the nose) risk exposing them-selves to the HCV infection.

The blood borne virus can survive for up to a week outsidethe body, and people using intranasal drugs may not noticesmall amounts of blood on a rolled up note or straw that theyare sharing to take the drug.

Hepatitis C attacks the liver which can cause cancer andcirrhosis which can lead to death if untreated, it also has fewand sometimes no symptoms which is why it is sometimesreferred to as the ‘silent killer’.

Drug users can prevent the spread of the disease and therisk they expose themselves to by ceasing to share the thingsthat spread it. If you think you may have been at risk fromhepatitis C, get yourself tested, HCV is treatable but you needto be diagnosed first. For more information log on to:

www.hepctrust.org and www.whatnottoshare.com

❧ B supported/B informed The recently launchedHepatitis B Foundation UK is the only charity in the UK

solely dedicated to supporting people with hepatitis B andraising awareness of this infectious disease.

It’s clear that the charity is meeting a real need as results ofa national survey of 2,279 UK adults carried out by YouGov inSeptember this year revealed alarming ignorance about hepa-titis B. For example, only 17 per cent of respondents knewthat hepatitis B is more infectious than HIV and only 11 percent were aware that hepatitis B can lead to cancer.

Penny Wilson-Webb, Hepatitis B Foundation UK Coordina-tor, doesn’t play down the challenge facing the charity: “Weknow we have a huge task ahead in raising awareness ofhepatitis B and in tackling the problem of stigma.” But she’supbeat about the charity’s ability to rise to the challenge:“We have a crack team headed up by world renowned viralhepatitis expert, Professor Arie Zuckerman. We’re also greatlyencouraged by patients and sponsors, and every time thephone goes and we talk with someone who’s feeling isolatedand afraid, we know we’re providing a much needed service”.

Web: www.hepb.org.uk Telephone: 01227 738279

Hepatitis C the way aheadThese are exciting times in hepatitis

C virus research, with impetusbeing given to the field by the ability toculture the virus and the new range ofantiviral compounds that provide hopefor combating infection. The 14thInternational Symposium on HepatitisC and related viruses is anticipated toprovide a forum for presentations onexciting developments not only in thesefields but also in other areas whereresearch on the virus is flourishing.

SymposiumThe 14th International Symposium onHepatitis C and related viruses will beheld from September 9th-13th 2007 inGlasgow, Scotland.

www.hcv2007.com/index.asp


What follows is a moving accountby a woman who passed the hep-

atitis C virus on to her daughter; and thesecond is an account by Jonathan Colamand his experience of coping with thedisease.

“My paediatrician assured me therewas a mere two per cent chance of mynext child being positive. A sign on theward toilet warned other mothers it wasonly to be used by me. At 18 months thetest confirmed my worst. After the ini-tial shock, the questions we never wantto ask about our children arose.”

“She was concernedabout the risk to other

pupils and staff – echoingthe reaction to AIDS 20

years ago”I was advised by Eliza’s consultant notto tell her school, I found out why whenher head teacher at primary school foundout. In her ignorance, she was concerned

about the risk to other pupils and staff –echoing the reaction to Aids 20 yearsago, the fear and needless panic.”

This year Eliza underwent treatmentfor hepatitis C. She suffered sideeffects. We survived, thanks to the sup-port of our wonderful paediatrician andThe Children’s Liver Foundation.Nothing can prepare you for the guiltattached to bequeathing a child an ill-ness, or the deceit one has to resort to inorder to protect them from people’sassumptions about this disease. Elizatested negative last month. I am stillliving with the disease.”

Jonathan Colam, 35 from Norfolk:“Although I wasn't diagnosed with hep-atitis C until 1999, I believe I contractedthe virus when I was 11 years old, from atreatment for haemophilia. That means Iwas infected with a virus which wasslowly and progressively damaging myliver for 17 years without knowing it!”

Despite being willing to have treat-ment straight after my diagnosis, I hadto wait five years to be finally given achance to clear this virus. By then I haddeveloped fibrosis and was suffering

Living with hepatitis C: two people’s experiencesThe stigma attached to hepatitis C can make peopleavoid getting tested and talking about their condition.The hepatitis C virus doesn’t discriminate, to see itspossible face you need only look in the mirror.

What the liver means to the bodyShould you find you are living withchronic hepatitis C you will find thehealth of your liver is jeopardized. Theliver is the largest and one of the mostimportant internal organs in the body.It performs over 500 functions whichmakes its efficient functioning essentialto health. It is the body’s great neu-traliser, filtering poisons from the bloodand helping to break down food intoenergy.

Living with chronic hepatitis CChronic hepatitis C is treatable; it canbe managed with monitoring, treat-ment and any necessary lifestylechanges. These are as simple as eating a

balanced diet to ensure your bodyreceives the nutrients it needs, makingsure you get enough rest and exercise.The most important change is to avoidalcohol as it speeds up the progression ofthe disease.

Liver damageDamage begins with persistent inflam-mation of the liver and eventually leadsto fibrosis (formation of scar tissue),possible accumulation of fat around theliver and cirrhosis (extensive scarring).Over time the liver hardens making itincreasingly difficult for blood to flowthrough it. As a result, the bloodbecomes diverted around the liver and aseries of serious complications mayoccur because important functions arenot performed. Hepatitis C can alsocause liver cancer.

Your liver, your life

The hepatitis B virus is transmittedthrough contact with blood or body

fluids of an infected person. While HIV,human immunodeficiency virus, thevirus that causes Aids is transmitted inthe same way, the hepatitis B virus is saidto be up to 100 times more infectious.

Transmission can occur via a wound,cut or scratch, the use of contaminatedmedical instruments, transfusion ofinfected blood products or via a contami-nated needle. The British Liver Trustexplains: “Just a tiny amount of bloodfrom an infected person will pass on the

infection if it gets into the bloodstream.It is important to know that the virus cansurvive in dried blood for up to a week.”

Those most at risk of infectioninclude those having unprotected sexwith infected individuals, injectingdrug users, babies of infected mothers,family members of infected individuals,healthcare workers who have direct con-tact with blood and people travellingand working in countries where thevirus is common, such as South-EastAsia, the Middle and Far East, SouthernEurope and Africa.

Drug useWorldwide most infections occur frominfected mother to child and from childto child. In developed countries, such asthe UK, the main way the virus ispassed from person to person is byinjecting drug use or unprotected sex.

Ignorance of the virus, an increase inforeign travel and the impact of immi-gration mean hepatitis B infection looksset to rise in the UK. The British LiverTrust says: “We can no longer ignore thethreat to public health. More easily acces-sible information and a greater awarenessof prevention measures are essential.”

Natural history of Hepatitis BThe World Health Organisation estimates that onethird of the world’s population has been infected withthe hepatitis B virus at some time in their life and ofthose who have been infected more than 350 millionwill have chronic, lifelong, infection. Although currentprevalence of chronic hepatitis B infection in the UK isrelatively low there are signs that it is on the increase.BY EMMA BOWLER

� Hepatitis B is transmitted throughcontact with blood

� The stigma attached to hepatitis C can make people avoid getting tested.

from lots of symptoms including liverpains, night sweats and mood swings.Living with hepatitis C was not easy andthe same applies to my treatment expe-rience. While taking the drugs, I suf-fered from a lot of side effects and evenneeded counselling.”

However, I am now virus free and canfinally realise what it is to be well.”

The liver has 500 functions, includinghelping to convert food into energy �


Treatment and prevention of thesediseases is a major challenge to

healthcare systems around the world.The major advances to address this chal-lenge have come from the use of innova-tive bioscience, whether in the develop-ment of vaccines or biopharmaceuticaldrugs.

TreatmentUntil the development of interferonalpha (IFN α) in the 1980s there wasno effective treatment for either hepa-titis B or C. Initially, interferon alphawas extracted from cultures of whiteblood cells from healthy people, butthis was abandoned in the late 1980sas genetic engineering enabled theproduction of sufficient quantities ofpure interferon alpha.

Interferon alpha has been used suc-cessfully to treat Hepatitis B. ForHepatitis C it is usually used in con-junction with other drugs with responserates of 50-80 per cent depending on thegenotype of the virus.

New antiviral drugs that prevent thereplication of the Hepatitis B or C virusin the body are now being developedand tested. One of the most recentdevelopments for patients that areresistant to interferon alpha or com-bined therapies is the use of antisensedrugs made from small interferingRNA which interferes with the expres-sion of a viral gene.

Another advance is the developmentof a therapeutic vaccine for Hepatitis Bwhich inserts the DNA coding sequencefor a virus protein into the body, which

revitalises the immune response againstthe virus.

PreventionBioscience and pharmaceutical compa-nies have also followed the age-old adagethat ‘prevention is better than a cure’

and vaccines for Hepatitis B have beenavailable since the 1980s. These containan inactivated virus protein and wereinitially produced from the plasma ofinfected patients in limited quantities.However, the use of genetic engineeringtechniques has allowed Hepatitis B anti-

gens to be produced on a large scale infermenters similar to those used forbrewing beer and has reduced costs. Asvaccination has been shown to work inalmost 90 per cent of cases, some coun-tries now routinely vaccinate childrenagainst Hepatitis B. A number of bio-science companies are working to devel-op new Hepatitis B vaccines that use dif-ferent antigens to those currently used.

However, for Hepatitis C it is a differ-ent story – no vaccine is currently avail-able. A number of companies are con-ducting research in this area. The poten-tial vaccines they have developed arenow in clinical trials and, if successful,will reach the market in the next fewyears.

Prevention and treatment of Hepati-tis B and C will remain a healthcarechallenge in the coming years, butshould become increasingly manageableas new vaccines and drugs being devel-oped by UK-based biopharmaceuticalcompanies, among others, becomeavailable for patients.

Hepatitis B and C: invisible killersHepatitis B and C kill more than two million peopleevery year and nearly one billion people are carriers ofone of viruses that cause these diseases. Both HepatitisB and C are spread through infected blood or sexualintercourse and can remain asymptomatic – or hidden- for a number of years. When the diseases strike theycan cause cirrhosis or liver cancer and can be fatal.BY AISLING BURNAND,CHIEF EXECUTIVE,BIOINDUSTRY ASSOCIATION

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Documents

Hepatitisdoc.mediaplanet.com/all_projects/1733.pdf · Symptoms, testing and treatments for hepatitis B 6 Hepatitis B: The vital statistics 7 Oral antiviral treatment of hepatitis