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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

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

Pediatric Considerations
  • Prevalence: 0.3%
  • Fewer symptoms or abnormal liver tests; more likely to clear spontaneously; slower rate of progression
Pregnancy Considerations
  • 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

Risk Factors

  • Screen patients with persistently elevated alanine aminotransferase (ALT) or known risk factors (1)[B]:
    • Hemodialysis
    • 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

General Prevention

  • 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

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