The incidence of cirrhosis is increasing and greater knowledge of its pathology has shown that, contrary to popular opinion, most cirrhosis is not the result of excessive alcohol. Research has also emphasised the difficulty of knowing which drinkers will suffer alcoholic cirrhosis and the variability of the amount of alcohol needed to cause it. Forty years ago hepatitis A, B, C (in all there are six genotypes of hepatitis C), D, E and G were all lumped together under the diagnosis of viral hepatitis or viral jaundice. Once hepatitis A and B had been recognised the rest were known as hepatitis non A and non B. Hepatitis C was identified only in 1989.

Hepatitis A, the most common hepatitis caused by virus, can be totally disabling in its acute phase, but it is clinically less important as sufferers recover and it never leads to cirrhosis. Immunisation against it is possible and indicated for all those who travel overseas.

Hepatitis B is a problem that was previously confined to those in the developing world, or to people whose work exposed them to contaminated blood or body fluids. Easy travel and mass migration has now made this a global problem and the immunisation programme needs to take account of these changes.

Delegates at the conference heard that an increasing number of patients are showing a long-term sustained response to treatment — the earlier it is started the better — with a comparatively new drug, Pegasys. Fortunately, therefore, treatment of hepatitis B is improving just as its pathology in the UK is altering for the worse.

The great worry is now the ubiquitous but frequently hidden hepatitis C. Between 270 million and 300 million people worldwide, 3 per cent of the world’s population, are infected with one of the six genotypes of hepatitis C. The numbers in the UK are unknown as nine out of ten people carrying the virus are unaware that they have it. It is estimated that there are at least 450,000 people with it.

Most are unaware that they have hepatitis C because its onset is insidious, hence the comparison with a ticking time bomb. Twenty to 50 years after some long-forgotten exposure to someone else’s blood or body fluid, 20 to 30 per cent of infected cases will suddenly find out the cause of their symptoms. Initially these may be no more troublesome than tiredness, increasing lethargy and general listlessness. Only when these feelings of general malaise are investigated by a blood test will the true diagnosis be made and treatment started.

The severity of the hepatitis C infection and its ease of treatment is likely to be related to the genotype. Genotype 1 is the most common in Britain and is also the most difficult to treat. Type 2 and 3, sometimes referred to as non-type 1 hepatitis C, respond more rapidly and more completely to modern treatment. Genotype 4, like genotype 1, is difficult to treat.

The good news announced in Vienna is that research has shown that the long-term treatment of genotype 2 and 3 with Pegasys (peginterferon alfa- 2a) and Ribavirin will now give optimum results with only 24 weeks’ treatment. This combination will, in two thirds of cases, clear the virus from the blood of a patient with hepatitis C. In patients who haven’t genotype 1 or 4, results of combination therapy are even better. In some trials more than 80 per cent of cases have now been cured. Eight years ago the overall percentage of cures when considering all the genotypes combined was only 6 per cent.

The next stage in beating hepatitis C is to produce an approved programme that will detect the disease at an earlier stage. We can learn from other countries where early diagnosis of hepatitis C is much better. This is one disease where early treatment would be a saving.

More prompt diagnosis would not only spare the minority who are going to develop cirrhosis and eventually die from liver failure after years of ill health; it would also save the NHS the bills that are associated with any chronic disease, and the social services the cost for caring for patients when they are no longer capable of work.

www.timesonline.co.uk/health