The HSE has announced plans to extend the clinical eligibility to Directly Acting Antivirals (DAAs) drug treatments as part of the next phase of the treatment plan to eliminate Hepatitis C in Ireland by 2026. Since late 2014 almost 700 people have been treated. This expansion will enable the HSE to improve access to an extended group of patients.

Currently there are an estimated 20,000 to 50,000 people in Ireland chronically infected with hepatitis C, more than half of whom are not aware of their infection, the stage of their disease and, in some cases, are not linked to care. 14,500 people have been tested and clinically diagnosed with Hepatitis C and have been notified to the Health Protection Surveillance Centre since Hepatitis C became a notifiable disease in 2004. However, epidemiological research indicates that the prevalence of the disease could affect up to twice that amount with approximately 700-800 new cases being notified each year.

Hepatitis C is often called “the silent pandemic”, partly because the virus takes so long to manifest itself in those infected and become symptomatic. Spread largely by blood-to-blood contact, in about 15-30% of cases the body’s natural defence system can eliminate the disease. The rest of those infected develop chronic HCV infection. For most infected persons, however, acquisition of the virus either causes no discernible symptoms, or non-specific ones such as general fatigue. The virus can persist for decades before the emergence of complications. Most patients – about 60-70% of those with HCV – develop chronic liver disease. 20-30% develop cirrhosis of the liver, which typically appears after two or three decades. Those patients with hepatitis C related cirrhosis also carry a higher than normal risk of developing hepatocellular carcinoma (HCC), the most common type of liver cancer.

Since 2014 highly successful treatments for hepatitis C have become available. These new treatments, using drugs known as Directly Acting Antivirals (DAAs), offer a cure for Hepatitis C in the majority of patients. The HSE established a National Hepatitis C Treatment Programme in 2015 to work with key stakeholders, clinicians and patients to develop a 10 year strategy to eliminate Hepatitis C through the delivery of new, effective treatments. The National Hepatitis C Treatment Programme is now moving to the next phase of the plan, having first prioritised seriously ill patients with end stage liver disease and cirrhosis in addition to patients infected through receipt of contaminated blood products.

Professor Suzanne Norris, Consultant Hepatologist and Clinical Lead for the National Hepatitis C Treatment Programme says, “We are moving to the next phase and extending the clinical eligibility for treatment criteria. This new phase enables us to include an additional 1,500 people to the treatment programme based on their clinical diagnosis. As a clinician who has been working with patients living with hepatitis C for many years, I am delighted that we are now in a position to offer this extremely effective and successful drug treatment to more patients. It is not often that we say we can cure a patient of a disease but these new medicines offer the chance of cure in excess of 90% of patients who complete a course of treatment.”

“Prior to the development of directly acting antivirals, clearance rates of HCV with drug regimens available would have been in the range of 50-75%, and lower in patients with cirrhosis. Those treatments, which required a weekly injection, were of long duration and associated with many side effects. Our goal is to continue in the short to medium term to extend treatment eligibility based on clinical need to patients with moderate liver disease, while continuing to treat patients with more advanced liver disease.”

Preventing the spread of the disease
Those most at risk of contracting the infection are injecting drug users but others are infected through blood. Just a small trace of blood can cause an infection, and the virus can survive outside of the body in patches of dried blood on surfaces, for at least 16 hours. Never share any injecting equipment, such as needles, syringes, spoons and filters. Also, do not share razors, toothbrushes or towels that might be contaminated with blood. Use a condom if you are having sex with a new partner.

You can reduce the risk of passing it on to others by:
• keeping personal items, such as toothbrushes or razors, for your own use
• cleaning and covering any cut or a graze with a waterproof dressing
• cleaning any blood from surfaces with household bleach
• not sharing needles or syringes with others
• not donating blood
• using condoms when having sex with new partners (seek advice about long-term partners)

For a list of national drug and alcohol services, please visit www.drugs.ie/services.
For confidential support, please contact the Helpline Freephone 1800 459 459.