Hepatitis C

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Basics

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.

Prevalence
  • 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

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