Public Health England recently published a report which summarised the impact of action plans in England towards the elimination of HCV as a public health threat by 2030. The 2 key impact areas in the path to HCV elimination are reduction in the number of individuals seriously ill or dying from HCV infection and reduction in the number of new and reinfections.
Until 2014, mortality from HCV-related diseases remained significant in England owing to the fact that individuals who had acquired infections decades ago had progressed to advanced liver disease and not received treatment adequately. The dawn of new direct-acting antiviral (DAA) drugs and their effective delivery through the Operational Delivery Networks has increased the potential for lowering the incidence of serious HCV-related end-stage liver disease (ESLD) or hepatocellular carcinoma (HCC) and reducing the consequent premature mortality.
The primary metrics for monitoring trends in HCV-related morbidity and mortality include:
- Estimated incidence of HCV-related ESLD/HCC;
- Number of individuals registered for liver transplant and number of transplants undertaken, post-hepatitis C cirrhosis being the indication; and
- Registered deaths resulting from HCV-related ESLD/HCC.
The incidence of HCV-related ESLD/HCC remained relatively stable between 2011 and 2015 but rose by 15% in 2016. The increase was found to be concentrated in certain geographical regions of England and warrants further investigation. Registrations for liver transplant at NHS Blood and Transplant fell substantially by 43% in the last 2 years compared to earlier years, reaching a nine-year low of 76 in 2016. Likewise, the rates of liver transplants patients with HCV-related disease decreased from 21% in 2008 to 11% in 2016.
Mortality from HCV-related ESLD and HCC more than doubled between 2005 and 2014; however, a 3% fall was recorded between 2014 and 2016. This fall in mortality for the first time in years is encouraging considering that mortality was predicted to further rise in the future. There is a strong likelihood that the decline in mortality is attributable to new DAA drugs introduced in 2014-2015.