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Hepatitis C is a global health problem with World Health Organisation estimates indicating that over 170 million individuals are currently infected with hepatitis C virus (HCV), the causative agent. Seroprevalence studies show wide variations between countries but in all cases it is among injecting drug users that the highest prevalence of HCV infection - 50% to 90% - is seen. Of infected individuals, approximately 80% will become chronically viraemic and of those who remain HCV RNA positive, a significant number will progress to cirrhosis and hepatocellular carcinoma as a function of the number and interaction of well established risk factors for advanced disease.
Anti-viral treatment in hepatitis C is relatively expensive and cures only a proportion of cases indicating that the patients selected for therapy should be those judged most likely to respond. Initial therapies have been largely superceded in their clinical effectiveness by more advanced treatments in adults and children which have shown greater efficacy in eradicating virus, in arresting disease progression to cirrhosis and hepatocellular carcinoma and in managing already well established disease. The ability of the older and particularly newer treatments in managing patients with HCV who are co-infected with HIV remains the subject of ongoing investigation as does the issue of HCV detection and treatment in the prison population where prevalence of infection greatly exceeds that of the general population.
Effective therapies need to be available for use within the NHS and when available need to be delivered effectively. The National Institute for Clinical Excellence has assisted in the process but problems with the delivery persist and it is hoped that the National hepatitis C Strategy will improve matters when properly implemented.
The current volume provides a comprehensive, fully referenced review of the current scientific evidence and expert clinical opinion for the investigation and management of HCV infection and disease in adults and children, setting this knowledge within the context of the organisation and delivery of clinical services and with reference to the broader health policy requirements of the NHS. As such it is of immediate relevance to hepatologists/gastroenterologists, virology, infectious disease and public health specialists, to clinical nurse specialists and to all those colleagues with an interest in or responsibility for the provision of effective, efficient services for the management of patients with hepatitis C. |
