Hepatitis News

NHS “failing” patients who catch hepatitis C

“Healthcare providers are failing our patients. They are becoming infected with hepatitis C not once, but multiple times.”

This was the stark warning of Rachel Jones from the Chelsea and Westminster Hospital in London to the 2008 Retrovirus Conference last month.

Jones was commenting on findings from a survey of patients who had been successfully treated for hepatitis C but who then developed signs of renewed infection.

Her study genetically analysed the patients’ hepatitis C virus to establish whether what they were seeing was a late relapse of infection – or a totally new infection.

The earlier treatment is attempted in hep C infection, the more likely treatment is to be successful. But there are rare cases where the hep C virus bounces back months after the apparently successful conclusion of treatment.

However, is also often not appreciated that the body does not develop natural immunity to hepatitis C – unlike hepatitis A and B. This means people can get re-infected with it if they are still at risk.

Jones found that of 211 patients from the Chelsea and Westminster and Royal Free Hospitals with HIV and hep C, 16 developed renewed signs of hep C after apparently successful treatment. Two of these were treated twice and developed a third apparent infection. The average time from ‘cure’ to second infection was only just over two years.

Jones was able to compare viral genes from the first and second hep C episodes in eight patients. In six of these the second virus was different from the first, establishing that this was re-infection and not treatment failure. In two cases, the second viruses were so similar it was not possible to tell if it was late treatment failure or re-infection from the same partner, or a group of partners sharing closely-related viruses. All the second infections were sufficiently similar, Jones said, to suggest that infection is occurring in a “closed population” of gay HIV-positive men are re-infecting each other after treatment.

All but two of the men with suspected hepatitis C reinfection had a concurrent sexually transmitted infection—usually syphilis (ten episodes), but also gonorrhoea (six cases) and new or recurrent herpes (three cases). This finding adds weight to their assertion that the men were continuing to practice sex that put them at a high risk of acquiring HCV.

Jones commented that her HIV positive gay male patients did not seem to be receiving enough information of support to protect themselves from reinfection.

She added: “We need a much stronger public health information and screening programme for hepatitis C.”

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