5-Minute Clinical Consult Explore these free sample topics:
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Systemic viral infection (acute and chronic) primarily involving liver
- Highest incidence ages 20 to 39; highest prevalence ages 40 to 59
- Males and non-Hispanic blacks more likely to be infected (1).
Age >60 years less likely to respond to therapy; treat earlier if able.
- Routine HCV testing is not indicated.
- Vertical transmission occurs in 6 of every 100 births in HCV-positive mothers; risk increases 2 to 3 times if HIV coinfection
- Breastfeeding is safe if no fissures.
- Prevalence: 0.3%
- Test children born to HCV-positive mothers with HCV Ab after 18 months or HCV RNA at 1 to 2 months for early diagnosis.
- Fewer symptoms; fewer abnormal liver tests; more likely to clear spontaneously; slower rate of progression
In 2013, CDC estimated there were 29,718 total new cases of hepatitis C. 2,138 of these were new acute cases.
- ~3.6 million in the United States (1.3%) are HCV Ab-positive.
- Prevalence is highest in persons born between 1945 and 1965 (2.6%) (1).
- 2.7 million have chronic HCV (HCV RNA-positive).
- HCV-related deaths are now more common than HIV-related deaths.
- Most common cause of chronic liver disease and transplantation in the United States
- Six genotypes (GT) were known. GT 1 is predominant form in the United States (75%). GT does not change during infection and 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
- Current sexual partners of HCV-positive persons
- HIV and hepatitis B infection
- Primary prevention
- Do not share razors/toothbrushes/nail clippers.
- Use and dispose needles properly through harm reduction programs.
- Practice safer 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