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Hepatitis C

Hepatitis C is a topic covered in the 5-Minute Clinical Consult.

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Systemic viral infection (acute and chronic) primarily involving liver


  • Highest incidence ages 20 to 39 years; highest prevalence between 40 and 59 years of age
  • Males and non-Hispanic blacks (1)

Geriatric Considerations
Patients >60 years are less responsive to therapy; important to initiate treatment early

Pregnancy Considerations
  • Routine HCV testing is not indicated.
  • Vertical transmission 6/100 births; risk doubles with HIV coinfection.
  • Breastfeeding is safe if no cracks or fissures on the breast.
Pediatric Considerations
  • Prevalence: 0.3%
  • Test children born to HCV-positive mothers with HCV Ab at 18 months or HCV RNA at 1 to 2 months.
  • More likely to clear spontaneously; slower rate of progression

Incidence has been rising since 2010. In 2014, there were 2,194 cases of acute HCV reported to the CDC, with an estimated 30,500 total new cases in the United States.

  • 2.7 to 3.9 million in the United States have chronic HCV (Ab+).
  • Prevalence highest if born 1945 to 1965 (2.6%) (1)
  • HCV-related deaths are more common than HIV-related deaths.
  • HCV is the most common cause of chronic liver disease and transplantation in United States.
  • Six known genotypes (GT) with 50 subtypes. GT 1 is predominant form in the United States (75%). GT predicts response to treatment.

Etiology and Pathophysiology

Single-stranded RNA virus of Flaviviridae family

Risk Factors

  • Exposure risks
    • Chronic hemodialysis
    • Blood/blood product transfusion or organ transplantation before July 1992
    • Hemophilia treatment before 1987
    • Household or health care–related exposure to HCV-infected body fluids (1.8% risk)
    • Children born to HCV-positive mothers
  • Risk behaviors and/or medical conditions
    • Prior history of injection drug use
    • Intranasal illicit drug use
    • History of incarceration
    • Tattooing in unregulated settings
    • Current sexual partners of HCV-positive persons
    • HIV and hepatitis B infection

General Prevention

  • Primary prevention
    • Do not share razors/toothbrushes/nail clippers.
    • Use and dispose needles properly through harm reduction programs.
    • Practice safe sex.
    • Cover cuts and sores.
  • Secondary prevention
    • No vaccine or postexposure prophylaxis available
    • Substance abuse treatment
    • Reinforce use of barrier contraception for HIV-seropositive coinfected with HCV.
    • Assess for degree of liver fibrosis/cirrhosis.

Commonly Associated Conditions

Diabetes, metabolic syndrome, iron overload, depression, substance abuse/recovery, autoimmune and hematologic disease, HIV, and hepatitis B coinfection

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Stephens, Mark B., et al., editors. "Hepatitis C." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116267/all/Hepatitis_C.
Hepatitis C. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116267/all/Hepatitis_C. Accessed April 20, 2019.
Hepatitis C. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116267/all/Hepatitis_C
Hepatitis C [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 20]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116267/all/Hepatitis_C.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hepatitis C ID - 116267 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116267/all/Hepatitis_C PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -