Description

Hepatitis C virus (HCV) is a systemic viral infection (acute and chronic) primarily involving liver.

Epidemiology

• Highest incidence between ages 20 and 39 years; highest prevalence between 40 and 59 years of age
• Males and non-Hispanic blacks (1)
• IV drug use accounts for 70% of new HCV infections.

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.

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
Incidence of acute HCV infection increased nearly 3-fold from 2010 to 2015. In 2015, there were 2,436 cases of acute HCV reported to the CDC, with an estimated 33,900 total new cases in the United States.

• Approximately 3.5 million persons 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 the 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
  • High-risk sexual behaviors
  • 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; cutaneous manifestations (necrotizing vasculitis, mixed cryoglobulinemia, porphyria cutanea tarda, lichen planus, erythema multiforme, erythema nodosum), HIV, and hepatitis B coinfection