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

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Basics

Description

Systemic viral infection (acute and chronic) primarily involving liver

Epidemiology

  • Highest incidence ages 20 to 39; highest prevalence ages 40 to 59
  • Males and non-Hispanic blacks more likely to be infected (1).

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

Pregnancy Considerations
  • 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.
Pediatric Considerations
  • 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

Incidence
In 2013, CDC estimated there were 29,718 total new cases of hepatitis C. 2,138 of these were new acute cases.

Prevalence
  • ~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

Risk Factors

  • 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

General Prevention

  • 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

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