Hepatitis C
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Basics
Description
Systemic viral infection (acute and chronic) primarily involving liver
Epidemiology
- 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
- 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.
- 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 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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