Natural history and management of hepatitis C in East London

Abstract

Chronic infection with the hepatitis C virus infection (HCV) affects over 170 million individuals worldwide. In this thesis the natural history and management of hepatitis C in North- East London was investigated. The prevalence of cirrhosis in patients with chronic hepatitis C rises with increasing duration of infection. In Asian patients infected at birth, infection over 60 years causes cirrhosis in 71 % of infected individuals. Since the rate of fibrosis progression in Asian patients is the same as that seen in Caucasian patients, it is likely that similar rates of cirrhosis will be seen in all patients who are infected with HCV for over 60 years. Factors found to be associated with fibrosis progression were:- age and alcohol excess. Insulin resistance was associated with fibrosis progression. However, elevated serum ferritin or hepatiC iron were not. Knowledge of hepatitis C in the East of London was examined and found to be poor despite the Department of Health information campaign. Educational meetings and postal surveys improved the level of knowledge of HCV. However as our group only assessed knowledge immediately after completion of the sessions, such a testing regime does not address long-term knowledge retention. We examined current and novel management strategies for patients with chronic HCV. Current therapy involves pegylated interferon and ribavirin. We found that insulin resistance was a poor predictor of sustained virological response. Chinese herbal treatments for hepatitis C are widely used but poorly studied. Our group designed a randomised controlled double blind study to assess whether Chinese herbal treatment is effective and results from this study show that recruitment and retention in trials of alternative therapies are problematic and that the herbal remedy had little effect on viraemia and quality of life, although liver function tests did improve a little.