- Christopher J A Duncan, research fellow1,
- Ewen Stewart, general practitioner2,
- Ray Fox, consultant in infectious diseases3
- 1Sir William Dunn School of Pathology, University of Oxford, Oxford OX1 3RE, UK
- 2Rose Garden Medical Centre, Edinburgh, UK
- 3Brownlee Centre for Infection, Tropical Medicine, and Counselling, Gartnavel Hospital, Glasgow, UK
A recent report from the Health Protection Agency in the United Kingdom estimates that 216 000 people, 90% of whom have injected drugs, are infected with the hepatitis C virus.1 Also at higher risk of infection are migrants from South Asia and eastern Europe and men who have sex with men.1 Of major concern is that half of the infected people who inject drugs who were surveyed (equivalent to nearly 100 000 people) were unaware of their diagnosis.1 This represents a huge burden of undiagnosed chronic hepatitis C in the UK and means that we should seriously consider targeted screening for hepatitis C. Such a shift in policy would have implications for primary care.
Targeted screening for hepatitis C fulfils World Health Organization criteria for screening.2 Because chronic infection has no specific symptoms, screening is the only way to identify people with hepatitis C before the onset of symptomatic liver disease. Serious complications such as cirrhosis develop in about 30% of chronically infected people after 20 years, and people who are infected with hepatitis who also have cirrhosis have a 5% annual risk of decompensated liver disease or hepatocellular carcinoma. …