Hunting the silent killer

Hepatitis C has a cure, but how do we find those who need it? Patrick Strudwick reports on one attempt to identify some of the estimated 100,000 undiagnosed people in the UK.

A young woman – jeans and boots and wild hair – is sitting in a cubicle in the Accident and Emergency department of the Royal London Hospital as a junior doctor swishes back the curtain.

“I’m just going to take some blood,” says Dr Emma Wallis.

“Just one?” asks the patient, spying the paraphernalia.

“Well, we’ll take a few bottles because you’ve had some palpitations so we need to test your kidneys, thyroid function and blood levels in general. Then this week in A&E, we’re offering everyone the chance of having an HIV, hepatitis B and hepatitis C test. Is that okay?”

The young woman looks confused and mildly irritated.

“I don’t like having blood taken as it is, one is enough, are you going to take loads?”

“No, it’s really easy, just one blood test, then we fill up the bottles and it’s just that much –” the doctor pinches about an inch “– extra blood needed. You wouldn’t notice it at all.”

“Yeah I don’t mind, yeah, okay…”

Wallis pulls out a syringe, siphons the blood and, with only that small amount of time and effort, adds one more patient to a landmark project that could change how we respond to the three of the most common life-threatening viral illnesses.

The pilot project involves offering this triple test for a week to all patients already having blood tests in ten A&Es in England and Scotland. It seeks not only to find undiagnosed people, but also to provide a crucial snapshot of how many, and who, might be living with HIV, hepatitis B and hepatitis C. Are the carriers in the populations we expect? Are the existing assumptions about the numbers affected correct? Or is there, as suspected by some, many more people affected, and in unforeseen groups?

Reference:

• The Hepatitis C Trust website is an invaluable resource for both patients, doctors and anyone interested in the disease. It contains lots of clearly presented, well-explained information.
• Page containing links to the NICE guidance on hepatitis.
• The NHS Choices site has lots of useful information on hepatitis, mostly to help patients understand the condition.
• Hepatitis C (Oxford American Infectious Disease Library), edited by Donald Jensen and Nancy Reau (Oxford University Press, 2013).
• Fascinating article by Sam Knight exploring new drug therapies for hepatitis C.