The epidemiology of hepatitis C in a UK health regional population of 5.12million

Background-The epidemiology and natural history of hepatitis C virus (HCV) infection in the UK are uncertain. Previous reports are from small or selec ted populations such as blood donors or tertiary referral centres. Aims-To study the epidemiology and natural history of HCV infection. Methods-Prospective study incorporating five centres within the Trent regio n. Patients were managed and followed up according to a commonly agreed pro tocol. Subjects-A total of 1128 HCV positive patients. Patients with haemophilia, human immunodeficiency virus, and chronic renal failure were excluded. Results-Between September 1991 and December 1998, 2546 anti-HCV positive pa tients were identified of whom 1128 (44%) were enrolled in the cohort. A ri sk factor(s) for infection was identified in 93.4% of patients who complete d the questionnaire; 81% of patients were HCV RNA positive. A total of 397 initial Liver biopsies were scored by a single pathologist. These showed a correlation between high alcohol intake and fibrosis score. Multivariate an alysis showed fibrosis to be associated with age over 40, past evidence of hepatitis B virus infection, and higher necroinflammatory grade but not wit h sex, viral genotype, maximum known alcohol intake, estimated duration of infection, or mode of transmission. Twelve (7.8%) of 153 patients who recei ved interferon therapy had sustained serum virus clearance. Sixty six patie nts have died during the follow up period, 31 with a Liver related cause of death. This represents a considerable excess over the expected death rate for a cohort of this age and sex distribution. Conclusions-HCV infection is an emerging health problem in the Trent region . Identifying risk factors for infection and disease severity will enhance understanding and facilitate improved intervention. An excess mortality in infected individuals is already evident in this unselected cohort.