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Acute/Chronic systemic viral infection primarily involving liver
- Predominant age: Highest incidence in ages 20–39; highest prevalence ages 30–49 years
- Predominant sex: Male = Female
Age >60 less likely to respond; treat earlier if able
- Prevalence: 0.3%
- Fewer symptoms or abnormal liver tests; more likely to clear spontaneously; slower rate of progression
- Vertical transmission 1–5% if HIV negative
- Breastfeeding safe if no fissures (1)
- Ribavirin is teratogenic; contraindicated in pregnancy and in male partners of pregnant/impregnable women without contraception
- In the US, 17,000 new cases of chronic hepatitis C virus (HCV) in 2010: Reports of acute infections rare (asymptomatic); 2/3 of people with chronic HCV are undiagnosed.
- Rate of new infections reduced since 1992 when effective donor blood screening began.
- ∼2.7–3.9 million in US (1–1.5%) HCV Ab+
- Prevalence is 3.25% in persons born between 1945 and 1965 (“baby boomers”).
- ∼3 million have chronic HCV (HCV RNA+)
- ∼12,000 deaths annually
- Most common cause of chronic liver disease and liver transplants in the US
- Genotype 1 predominant (75% of cases)
Etiology and Pathophysiology
Single-stranded RNA virus of family Flaviviridae
- Screen patients with persistently elevated alanine aminotransferase (ALT) or known risk factors (1)[B]:
- Blood ± product transfusion before 1992
- Hemophilia treatment before 1987
- IV drug use: 60–70% of new infections
- High transmission 1st use; “once” is high risk
- Sexually active homosexual male
- HIV/Hepatitis B infection
- Household exposure to infected body fluids
- Organ transplant recipients before 1992
- Children of HCV+ mothers (test >18 months)
- Current sexual partners of HCV+ persons
- Possible risk factors:
- Inhaled cocaine use; body piercing/tattoos; needle sticks
- CDC: Screen all adults born between 1945 and 1965 once for hepatitis C.
- No vaccine/postexposure prophylaxis available
- HCV Ab+ does not confer immunity to reinfection.
- Do not share razors/toothbrushes/nail clippers.
- Use and dispose of needles properly.
- Sexual transmission rare in long-term partners (1.5%) if monogamous (1)[C]
Commonly Associated Conditions
Diabetes, metabolic syndrome, iron overload, depression, substance abuse/recovery, autoimmune and hematologic disease, HIV, and hepatitis B coinfections