Request

I am writing regarding a query from a patient who believes he was among the rare group of patients with hepatitis C who cleared the virus after a period of chronic infection. I would appreciate you sharing your position on this well recognised, but uncommon, occurrence and I would be grateful if you could share with me the names of the current medical advisors.

Response

Cleared Hepatitis C Virus

England Infected Blood Support Scheme (EIBSS) Medical Assessors recognise this condition but acknowledge that it is rare. Because of this rarity, there needs to be reasonable evidence to support this diagnosis.

It is understood that PCR tests were not widely available to support this diagnosis prior to mid-1990s, and therefore the following is required:

• If PCR test evidence is available, our criteria to meet would be evidence of HCV RNA (+) by PCR for longer than 6 months.

• If PCR test evidence is not available, we would require evidence of HCV Ab positivity and evidence of abnormal ALT (or AST) for longer than 6 months, with the ALT not explained by a more likely alternate cause.

Insufficient evidence would include:

• Symptoms such as fatigue or nausea without evidence of abnormal ALT. • Abnormalities in alkaline phosphatase would not be sufficient. • A clinician writing in the notes that a patient has hepatitis C is not, on its own, sufficient to diagnose chronic hepatitis C. In this context, in the 1990s for instance, when PCR was not necessarily available some patients were given this label just on the basis of a positive Ab test.

Annex A below provides a table of definitions to accompany the above.

The current EIBSS Medical Assessors are as follows:

• Dr. Belinda Smith
• Dr. Catherine Smith
• Dr. Margaret Bassendine
• Professor Mark Nelson
• Professor Brian Gazzard

Please note that the above named do not consent to being contacted in relation to their work. All queries or requests to contact them should be made through EIBSS. In addition, they may not be contacted to further any appeal/grievance which must be done via the EIBSS appeal process.

Annex A

PCR Test - Polymerase Chain Reaction Test HCV RNA (+) - Hepatitis C Virus Ribonucleic Acid positive Ab positivity - Antibody positive abnormal ALT - Abnormal Alanine Aminotransferase (or AST) - Aspartate Aminotransferase

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