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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
Age >60 years less likely to respond to therapy; treat earlier if able.
- 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
- 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
- Exposure risks were as follows:
- 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)
- 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