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