The UK Health Security Agency (UKHSA) has launched genomic surveillance of hepatitis C virus (HCV) in a bid to monitor drug resistance, tackle harder to treat viral strains, and detect outbreaks sooner.
The technology will allow a better understanding of treatment outcomes to inform national treatment programmes as well as transmission patterns to stop ongoing transmissions among populations at risk of hepatitis C.
New data published recently by the UKHSA show a major drop in chronic HCV infections across England. The number of people aged over 16 with chronic HCV has fallen by 56.7% since 2015, from an estimated 129,400 to 55,900 in 2023.
The decline in people living with the virus is largely due to the efforts of NHS England’s HCV Elimination Programme, with increased testing and improved access to Direct Acting Antivirals (DAAs) with improved treatment efficacy since 2015. Hepatitis C-related mortality is now at its lowest in nearly 10 years, falling from 0.69 per 100,000 people in 2015 to 0.41 per 100,000 in 2023.
However, resistance to antivirals does emerge. Data from 2023 showed that 5% of subtype 1a samples from patients who have not had treatment before, were resistant to one class of HCV antiviral drugs. In addition, some HCV subtypes that are prevalent in Asia and sub-Saharan Africa, but are also found in this country, show inherent resistance to some DAAs.
In order to monitor this situation more closely, UKHSA has established a genomics surveillance programme, to look for genetic markers of drug resistance.
Dr Monica Desai, Hepatitis C lead at UKHSA, said: “Early diagnosis and effective anti-viral drugs have played a huge part in driving down hepatitis C in this country, but we must always be alert to the emergence of resistance putting progress in jeopardy. Through our genomic surveillance programme we can monitor changes in how the virus is responding to treatment and more quickly respond if resistance increases.”
HCV is a bloodborne virus that can cause life-threatening liver disease and cancer. However, those infected often have no symptoms until many years later when their liver has been badly damaged. When symptoms do occur, they can often be non-specific, such as tiredness or loss of appetite, and be dismissed or mistaken for other conditions. Early detection and treatment can also reduce the risk of passing the virus onto others.
The virus spreads through blood-to-blood contact, most commonly in the UK by sharing needles, syringes or other non-sterile injecting equipment.
NHS England launched a home testing service in May 2023, with over 60,000 people ordering tests so far. The testing service is available to everyone over the age of 18 in England.
Professor Sir Stephen Powis, National Medical Director at NHS England, said: “Eliminating hepatitis C in this country will represent one of the most significant health achievements of our time. The NHS England elimination programme has already made incredible progress in driving down the numbers of people living with the virus through the provision of more than 100,000 treatments since 2015 – with 8 in 10 treatments going to the most deprived people in the country, tackling health inequalities in the process.
“The mission now is to sustain these achievements through testing programmes that will identify the remaining people living with hepatitis C, and this last push will require the strengths of all our partners across government, industry and the charity sector.”