Description

Systemic viral infection involving the liver

Epidemiology

Geriatric Considerations
Patients >60 years are less responsive to therapy (1),(2).

Pregnancy Considerations

• Routine prenatal HCV testing
• Vertical transmission rate is ~6/100 births; risk doubles with HIV coinfection.
• Breastfeeding is safe if there are no cracks or fissures (3).

Pediatric Considerations

• Prevalence: 0.3%
• Test children born to HCV-positive mothers.
• 20% of infants clear HCV; 30% have chronic active HCV.
• HCV-positive children have no restrictions for participation in regular childhood activities.
• Treatment starts ≥3 years of age (2),(3).

Incidence

• Highest incidence is between 20 and 39 years of age.
• Most common in males and non-Hispanic whites
• IV drug use accounts for ~60–70% of new cases.

Prevalence

• HCV is the most common cause of chronic liver disease and transplantation in the United States.
• HCV-related deaths are more common than HIV-related deaths.
• Eight known genotypes (GT) with 86 subtypes. GT 1 is the predominant form, 75% in United States, ~46% worldwide. GT predicts response to treatment (1),(2),(4),(5).

Etiology and Pathophysiology

Single-stranded RNA virus of Flaviviridae family (4)

Genetics

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

Risk Factors

• Exposure risks
  • Chronic hemodialysis
  • Blood/blood product transfusion or organ transplantation before July 1992
  • Household or health care–related exposure
  • Children born to HCV-positive mothers
• Other risks:
  • Prior/current history of injection drug use
  • High-risk sexual behaviors, intra-nasal illicit drug use
  • HIV and hepatitis B infection, history of incarceration
  • Tattooing in unregulated settings
  • Sharing personal hygiene products—razor, toothbrush, nail clippers
  • Needle stick injury in health care setting (3)

General Prevention

• Primary 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).
• Secondary prevention
  • No vaccine or postexposure prophylaxis available
  • Substance abuse treatment
  • Barrier contraception
  • Assess for degree of liver fibrosis/cirrhosis (3).

Commonly Associated Conditions

Extrahepatic manifestations/associated diseases (3)

• Hepatitis B coinfection, HIV coinfection
• Mixed cryoglobulinemia
• HCV-related renal disease—most commonly membranoproliferative glomerulonephritis
• Diabetes mellitus/insulin resistance
• Dermatologic manifestations: necrotizing vasculitis, mixed cryoglobulinemia, porphyria cutanea tarda, lichen planus, erythema multiforme, erythema nodosum
• Autoimmune conditions
• Lymphoma—most commonly non-Hodgkin
• Depression, substance abuse/recovery