Planning for the healthcare burden of hepatitis C infection: Hepatitis C genotypes identified in England, 2002-2007.

BACKGROUND: Identification of HCV genotype is a prerequisite for anti-viral treatment in England. Treatment length and sustained virological response rates vary by genotype. Therefore knowledge of circulating HCV genotypes is important for health-care providers. OBJECTIVES: To describe the HCV genotypes identified in English laboratories and to investigate changes over time; sub-analysis of young adults (15-24 years) to provide information on recently circulating genotypes. STUDY DESIGN: Data from the national reference laboratory and 19 English laboratories participating in the sentinel surveillance of hepatitis testing study were analysed. Multinomial regression was used to investigate trends in genotypes identified between 2002 and 2007. RESULTS: HCV genotypes were available for 18,031 individuals. The majority (89%) of people were genotypes 1 and 3; 3a was the single largest subtype. Half of people born between 1960 and 1989 were genotype 3a and the majority of South Asian people were genotype 3a. People born pre-1940 were nine times more likely to have genotype 1b than 3a. The proportion of 1b infections, relative to 3a, declined over time, but, after adjusting for birth cohort, this effect disappeared. There was no evidence of a relative change in 1a infections. CONCLUSIONS: This is the largest study of genotypes identified in England to date. Changes in genotypes over time were due to decreased genotyping of older individuals. As the population ages, the proportion of more difficult to treat genotypes may decline, leading to possible cost-savings for health-care providers, with a higher chance of achieving sustained virological response.

Monitoring HIV testing in diverse healthcare settings: results from a sentinel surveillance pilot study.

OBJECTIVES: To assess the feasibility and utility of sentinel laboratory surveillance of HIV testing as a tool for understanding patterns and trends in HIV testing in a range of healthcare services. METHODS: Data on all anti-HIV antibody tests carried out by the Leeds Teaching Hospital Trust laboratory over a 12-month period were collated and analysed by demographic information and place of test. Individuals who tested positive were matched to the national database of HIV diagnoses to identify the proportion newly diagnosed with HIV. RESULTS: 41,013 individuals over 1 year of age were tested at least once for HIV during the study period, of whom 0.8% (n=312) were positive. The majority of individuals (77%) were tested in a genitourinary medicine (GUM) clinic or as part of antenatal care, while routine testing of people undergoing haemodialysis, fertility treatment or occupational health screening accounted for a further 13% of those tested. Few individuals (<4%) were tested in general practice. Of the 312 people testing positive, 286 could be matched to the HIV national database and 173/286 (60%) were identified as newly diagnosed. CONCLUSIONS: Little HIV testing is currently performed outside GUM and antenatal settings. Monitoring of HIV testing is essential given new guidelines recommending the expansion of testing in a wide range of settings. Sentinel laboratory surveillance can provide useful demographic data on people tested for HIV and can assess trends in testing over time. Data on HIV testing could be incorporated into existing hepatitis sentinel surveillance, allowing rapid scale-up of this surveillance scheme with minimal effort.

Hepatitis C testing in sexual health services in England, 2002-7: results from sentinel surveillance.

OBJECTIVES: To describe testing for hepatitis C virus (HCV) in sexual health services in England between 2002 and 2007, using data from a sentinel surveillance study of hepatitis testing. METHODS: Data on all anti-HCV tests carried out between 2002 and 2007 were collected from 20 participating laboratories. Test requests originating in sexual health services were identified, allowing analysis of the demographic and clinical characteristics of individuals tested in this setting. KC60 statutory returns data were used to estimate the proportion of new genitourinary medicine clinic attendees tested for hepatitis C each year. RESULTS: 90 424 individuals were tested for anti-HCV in 100 sexual health clinics; 3.2% (n=2858) were found to be positive. Multivariable analysis showed anti-HCV status to be associated with male sex and a reported history of injecting drug use. In those clinics for which data on trends were available, testing for anti-HCV increased over the study period and the percentage testing positive decreased. KC60 data suggested that most clinics tested less than 20% of new patients for anti-HCV, although the proportion of patients tested increased over time. CONCLUSIONS: Sexual health services have become increasingly important locations for hepatitis C testing in England, although the proportion of patients testing positive is low compared with other settings. We suggest that testing in this setting could be better targeted to those most at risk of infection by thorough investigation of risk factors among service users.