In this month's Gut, Ward and colleagues1 report their study of the prevalence of hepatitis C virus (HCV) in women attending an inner London obstetric department (see page 277). The study was well designed and carefully executed. The methodology is valid and the findings are important. The authors make three key observations: that the prevalence of HCV in this population is high (0.8%); that uptake and acceptability of screening for HCV is good; and that many of the cases could not be identified by clinical criteria alone. Each of these findings is important in its own right. Together they reaffirm the importance of hepatitis C as a healthcare problem. They support the case for further investigation of screening strategies for HCV and suggest that antenatal screening should be considered carefully.

Accurate knowledge of the prevalence of a disease is particularly important when it is serious and treatable. In the 1970s the disease later recognised as hepatitis C was thought to be an inconsequential transaminitis that followed blood transfusion. Since the cloning of HCV in 1989, increasing knowledge of the natural history of hepatitis C has revealed a more serious outcome, at least for the minority of individuals who develop progressive fibrosis leading to cirrhosis, liver failure, and liver cancer.2 In the past year, effective treatment has been licensed3and even more effective therapies may follow. Now that more is known of the natural history of hepatitis C and the clinical and cost effectiveness of treatment, accurate knowledge of the true prevalence of HCV infection is very important for those plan- ning, funding, and delivering care to HCV infected individuals.

Early studies …