Ireland not on track to eliminate hepatitis C

High rate among vulnerable people
  • Deborah Condon

Ireland has one of the highest rates of hepatitis C infection among vulnerable groups in Europe, an international seminar in Dublin has been told.

Speaking at the seminar, Charles Gore, who is CEO of the World Hepatitis C Alliance, noted that 73% of people who inject drugs in Ireland have the virus, while 35% of homeless people here are also infected.

Hepatitis C is an infection of the liver caused by the hepatitis C virus. An estimated 30,000 people are infected, however many of these may be unaware they have the virus because they do not have any symptoms, or they have fju-like symptoms that can be mistaken for something else.

A person can become infected if they come into contact with the blood of an infected person. Drug users who share needles are at particular risk. While there is no vaccine against hepatitis C, it can be successfully treated. However, if left untreated, it can lead to significant liver damage.

Up to 20% of people with the virus will develop irreversible cirrhosis, which can result in liver failure. Those with cirrhosis also have an increased risk of developing liver cancer.

The seminar was told that there are indications that there may be up to 750 new infections of hepatitis C in the first nine months of 2017. This signals a worrying increase in the number of people contracting the virus and is already higher than 2016's total figure of 652.

According to Mr Gore, Ireland is one of the few countries in Europe that is not on track to eliminate hepatitis C by 2030 based on current policy.

He said that drug costs for the virus could be, on average, three times the cost in the UK and he noted that other countries who are further along in this journey have secured elimination deals with drug companies. This means that pharmaceutical costs are reduced as treatment rates increase.

However, aside from prescription costs, he emphasised the importance of focusing on diagnosis, outreach, and prevention.

"Working proactively to eliminate the virus will also eliminate much of the cost associated it. People won't get liver cancer because of the virus, they won't be progressing to cirrhosis. There won't be the same need for drug treatment. It makes sense, from a health and cost point of view, that Ireland sets its sights on making this disease a rare disease, moving with the rest of Europe," Mr Gore commented.

Also speaking at the seminar, Dr Jack Lambert, a consultant in infectious diseases at the Mater Hospital in Dublin, pointed out that the Government allocates €30 million to the Hepatitis C programme, however this is mostly for the purchase of drugs.

"The money is there, that's not the issue. What is the problem is that there is a disconnect between what needs to be done and what is being done. We, the people on the ground, need to be able to decide how the money is used. It should not be used for drug treatment almost exclusively," he insisted.

He said that his patients need much more than just drugs, such as ‘care and outreach in homeless services, drug treatment services in methadone GP practices and peer support'.

"We're not prioritising these and so we are not doing the right things to make elimination a reality," he said.

Dr Lambert also pointed out that there is a discrepancy between accepted notification figures for the virus and the reality of the situation on the ground. This has led to a big gap between treatment numbers and those actually infected.

"At its lowest estimate, we have 30,000 with the virus in the country. So far we have treated over 2,000 people and we have another 1,000 left waiting to be treated. That adds up to 3,000 people. So where are the remaining 27,000? We have to seek and treat, not just wait for people to come to us," he said.

The seminar, 'A Vision of Elimination: Stop Hepatitis C', was held in Buswell's Hotel in Dublin city.

 

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