Hepatitis C
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Basics
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
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Basics
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
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