PhdChronic infection with the hepatitis C virus infection (HCV) affects
over 170 million individuals worldwide. In this thesis the natural
history and management of hepatitis C in North- East London was
investigated.
The prevalence of cirrhosis in patients with chronic hepatitis C
rises with increasing duration of infection. In Asian patients
infected at birth, infection over 60 years causes cirrhosis in 71 % of
infected individuals. Since the rate of fibrosis progression in Asian
patients is the same as that seen in Caucasian patients, it is likely
that similar rates of cirrhosis will be seen in all patients who are
infected with HCV for over 60 years. Factors found to be
associated with fibrosis progression were:- age and alcohol
excess. Insulin resistance was associated with fibrosis
progression. However, elevated serum ferritin or hepatiC iron
were not.
Knowledge of hepatitis C in the East of London was examined
and found to be poor despite the Department of Health
information campaign. Educational meetings and postal surveys
improved the level of knowledge of HCV. However as our group
only assessed knowledge immediately after completion of the
sessions, such a testing regime does not address long-term
knowledge retention.
We examined current and novel management strategies for
patients with chronic HCV. Current therapy involves pegylated
interferon and ribavirin. We found that insulin resistance was a
poor predictor of sustained virological response. Chinese herbal
treatments for hepatitis C are widely used but poorly studied. Our
group designed a randomised controlled double blind study to
assess whether Chinese herbal treatment is effective and results
from this study show that recruitment and retention in trials of
alternative therapies are problematic and that the herbal remedy
had little effect on viraemia and quality of life, although liver
function tests did improve a little