Hepatitis C is a topic covered in the 5-Minute Clinical Consult.

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Systemic viral infection (acute and chronic) primarily involving liver


  • Highest incidence in ages 20–39 years; highest prevalence ages 30–49 years
  • Male = female

Geriatric Considerations
Age >60 years less likely to respond to therapy; treat earlier if able.

Pediatric Considerations
  • Prevalence: 0.3%
  • Test children born to HCV-positive mothers after 18 months
  • Fewer symptoms; fewer abnormal liver tests; more likely to clear spontaneously; slower rate of progression
Pregnancy Considerations
  • Vertical transmission occurs in 4 of every 100 births in HCV-positive mothers; risk increases 2–3× if HIV coinfection.
  • Breastfeeding safe if no fissures
  • In 2011, CDC estimated there were 16,500 new cases, of which 1,229 were new cases of acute hepatitis C (incidence of 0.4 cases per 100,000 population), the first increase in incidence in 7 years.
  • In 2011, 34 states reported 185,979 cases of hepatitis C (past or present; cannot differentiate those who spontaneously cleared). 45–85% are unaware they are infected (1).
  • ~3.2 million in United States (1–1.5%) HCV Ab+
  • Prevalence is 3.5% in persons born between 1945 and 1965 (“baby boomers”).
  • ~3 million have chronic HCV (HCV RNA+).
  • ~15,000 deaths HCV-related in 2007, overtaking HIV-related deaths
  • Most common cause of chronic liver disease and liver transplantation in the United States
  • Genotype 1 is predominant form (75% of cases)

Etiology and Pathophysiology

Single-stranded RNA virus of Flaviviridae family

Risk Factors

  • Exposure risks were as follows:
    • Hemodialysis
    • Tattoo in unregulated setting
    • Blood/blood product transfusion or organ transplantation before 1992
    • Hemophilia treatment before 1987
    • Household or health care–related exposure to infected body fluids
    • History of incarceration
    • Children born to HCV-positive mothers
    • Current sexual partners of HCV-positive persons
  • Risk behaviors and/or medical conditions were as follows:
    • Any prior history of injection drug use
    • Intranasal illicit drug use
    • HIV and hepatitis B infection
    • Unexplained chronic liver disease or chronic hepatitis including elevated alanine aminotransferase levels (ALT)

General Prevention

  • Primary prevention
    • Do not share razors/toothbrushes/nail clippers.
    • Use and dispose of needles properly.
    • Needle/syringe exchange programs
    • Sexual transmission rare in monogamous long-term partners
  • Secondary prevention
    • CDC/USPSTF/AASLD/IDSA: Screen all adults born between 1945 and 1965 once for hepatitis C.
    • Annual testing for those who inject drugs and for HIV-seropositive men who have sex with men (MSM).
    • No vaccine or postexposure prophylaxis currently available
    • Substance abuse treatment
    • Reinforce use of barrier contraception for HIV-seropositive coinfected with HCV.

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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