The third day of expert hearings was focused on expert discussion of clinical hepatitis. The experts who gave evidence today were Professor Graham Cooke Professor of infectious diseases at Imperial College London, Dr Aileen Marshall Consultant Hepatologist at the Royal Free Hospital. Dr Scott Jamieson an NHS GP who sits on Royal College of General Practitioners Scottish Council. Also sat on the experts panel was Dr Katie Jeffery NHS Consultant Microbiologist, Director of infection prevention and control and finally, Professor John Dillon, Professor of Molecular and Clinical Medicine at University of Dundee. This blog will provide a summary of the questions placed to the experts.
What is hepatitis & What is viral hepatitis?
The experts explained hepatitis simply means inflammation of the liver. The inflammation is picked up by blood tests, specifically, ALT liver function tests. The experts explained there are five main viruses, A, B, C, D and E. The experts stated 95% of viral hepatitis comes from hepatitis C & D.
The experts pointed out that viral hepatitis is a parasite that replicates itself. The virus does not want to destroy the cells but the virus changes protein production. An individual’s response to the virus all depends on their immune system and how their body reacts to the virus.
What’s ALT and AST?
The experts stated that ALT levels are monitored through blood tests. ALT levels are an indicator as to how damaged an individual’s liver may be. The higher the ALT level the more extensive the damage to the liver. Counsel to the Inquiry, Jenni Richards QC pointed out that ALT testing is not used to diagnose hepatitis. The experts went onto say in their evidence that AST tests are also used to test liver functioning levels and are an indicator of fibrosis.
What are the various genotypes and sub types of hepatitis?
The experts began answering this question by stating genotype 1 remains the most common strain of hepatitis in the Western World. Whilst genotype 3 is the most common strain the Indian sub-continent.
One expert stated that research indicated carriers of genotype 3 health deteriorated more rapidly.
Another expert concluded they did not find clear data on whether or not you can be infected with more than one genotype at one time.
Testing for hepatitis – how has this evolved?
The experts introduced this section of evidence by discussing testing. The experts stated that most of the first tests for hepatitis C were based on detection of antibody that then went onto detect the viruses.
One of the experts went onto say we now have first and second generation tests for hepatitis C. It was noted by the experts there had been an occurrence of false negative tests for hepatitis C. This had been particularly prevalent in individuals who produced poor antibody responses.
Conclusion of expert evidence on hepatitis
The final part of the day’s evidence was centered around treatment for hepatitis and how this had changed over the years. The experts stated that it was difficult to determine whether or not someone had cleared hepatitis when they were receiving treatment. It was also concluded that many individuals who received treatment for hepatitis C went onto to develop depression.