Hepatitis C

BASICS

DESCRIPTION

Systemic viral infection involving the liver

EPIDEMIOLOGY

Geriatric Considerations

  • Patients aged >60 years may be less responsive to therapy (more likely to have advanced fibrosis or cirrhosis at time of diagnosis) (1).

Pregnancy Considerations

  • Routine prenatal HCV testing
  • For HCV-infected mothers, retest HCV RNA postpartum to evaluate for spontaneous clearance.

Pediatric Considerations

  • Test children born to HCV-positive mothers (ideally at 2 to 6 months of age).
  • HCV-positive children have no restrictions for participation in regular childhood activities.
  • Treatment starts ≥3 years of age (1),(2)

Incidence

  • Incidence continuously increased from 2010–2021, and declined for the first time in 2022. Incidence of acute hepatitis C has doubled since 2013.
  • IV drug use accounts for ~60–70% of new cases.

Prevalence

  • Most common blood-borne infection in the U.S.

ETIOLOGY AND PATHOPHYSIOLOGY

  • Enveloped, single-stranded RNA virus
  • Seven known genotypes (GT) with 86 subtypes.
  • GT 1 is the predominant form in United States (75%) and worldwide (46%) (1).

Genetics

  • No known predisposing genetic factors.
  • Transmission occurs primarily via parenteral exposure to infected blood.

RISK FACTORS

Exposure risks

  • IV drug use, HIV infection, chronic hemodialysis
  • Blood/blood product transfusion or organ transplantation before July 1992
  • Household or health care–related exposure
  • Children born to HCV-positive mothers

GENERAL PREVENTION

  • Do not share hygiene products.
  • Use clean needles and dispose of needles properly. Do not share needles; cover cuts and sores.
  • Practice safe sex (condoms).

COMMONLY ASSOCIATED CONDITIONS

  • Hepatitis B coinfection, HIV coinfection
  • Mixed cryoglobulinemia
  • HCV-related renal disease—most commonly membranoproliferative glomerulonephritis

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