The epidemiology of hepatitis C in a UK health regional population of 5.12 million

Abstract

Background: The epidemiology and natural history of hepatitis C virus (HCV) infection in the UK are uncertain. Previous reports are from small or selected populations such as blood donors or tertiary referral centres.

Aims: To study the epidemiology and natural history of HCV infection.

Methods: Prospective study incorporating five centres within the Trent region. Patients were managed and followed up according to a commonly agreed protocol.

Subjects: A total of 1128 HCV positive patients. Patients with haemophilia, human immunodeficiency virus, and chronic renal failure were excluded.

Results: Between September 1991 and December 1998, 2546 anti-HCV positive patients were identified of whom 1128 (44%) were enrolled in the cohort. A risk factor(s) for infection was identified in 93.4% of patients who completed the questionnaire; 81% of patients were HCV RNA positive. A total of 397 initial liver biopsies were scored by a single pathologist. These showed a correlation between high alcohol intake and fibrosis score. Multivariate analysis showed fibrosis to be associated with age over 40, past evidence of hepatitis B virus infection, and higher necroinflammatory grade but not with sex, viral genotype, maximum known alcohol intake, estimated duration of infection, or mode of transmission. Twelve (7.8%) of 153 patients who received interferon therapy had sustained serum virus clearance. Sixty six patients have died during the follow up period, 31 with a liver related cause of death. This represents a considerable excess over the expected death rate for a cohort of this age and sex distribution.

Conclusions: HCV infection is an emerging health problem in the Trent region. Identifying risk factors for infection and disease severity will enhance understanding and facilitate improved intervention. An excess mortality in infected individuals is already evident in this unselected cohort.

Figure 1

Trent Hepatitis C Study Group assessment and management protocol (up to 1998). HCV, hepatitis C virus; LFTs, liver function tests; PCR, polymerase chain reaction.

Figure 2

Percentage of new referrals on a yearly basis during the study period, 1991-1998.

Figure 3

Highest known alcohol consumption in relation to hepatic fibrosis grades 3 and 4 in 331 patients with hepatitis C (numbers in boxes represent number of patients).