NINE out of ten people with the hepatitis C virus in the United Kingdom are unaware that they have this tiny ticking time bomb coursing through their veins and infecting their livers. Hepatitis C is a virus that takes time to make its presence felt: its initial symptoms are so trivial as to go unnoticed, and the patient may not realise that the incident which caused the trouble could give rise to a potentially fatal liver condition 20 or 30 years later. The first symptoms are often tiredness, listlessness and lethargy, a more literary way of describing the diagnostic term TATTY: doctors’ shorthand for patients who complain that they are tired all the time.

There is an increasing demand for patients who could have been at risk of catching hepatitis C to be tested if they have these symptoms. It is shaming that whereas in France doctors have diagnosed the disease in half the estimated number of patients — and they have a government plan to identify the rest within the next two years — in the UK 90 per cent remain undetected. Only by uncovering the presence of hepatitis C while it is still asymptomatic will many thousands of patients avoid a premature death following a lengthy and expensive illness.

Any occupation or habits that might bring people into contact with someone else’s blood or body fluids increases the chance of catching hepatitis C. Although blood is the most important vector, and in the past cases were spread by blood transfusion and blood products, these sources are now eliminated (although not all those who were infected before blood screening will yet have been uncovered). Fifty per cent of regular intravenous drug-users become infected, and others may become positive through contact with other body fluids.

One new development is that the National Institute for Clinical Excellence (Nice) approves of the use of pegylated interferons and decrees that these should be made available as they are clinically effective and highly cost-effective. And today the results of an international trial were announced: when patients with hepatitis C who also have HIV took a treatment that combined Pegasys peginterferon alfa 2a 40kDa with Copegus ribavirin, it was found that the chances of ridding the body of hepatitis C were trebled, or even quadrupled, when the most resistant forms of hepatitis C were involved. One in three of the HIV-positive people in the UK also suffers from hepatitis C. Complications of the liver are their most common cause of death.