Hepatitis C

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Basics

Description

Systemic viral infection involving the liver.

Epidemiology

Geriatric Considerations
Patients >60 are less responsive to therapy (1),(2)

Pregnancy Considerations

  • Routine prenatal HCV testing.
  • Vertical transmission rate is ~6/100 births; risk doubles with HIV coinfection.
  • Breastfeeding safe if no cracks or fissures (3).

Pediatric Considerations

  • Prevalence: 0.3%
  • Test children born to HCV-positive mothers.
  • 20% of infants clear HCV, 30% have chronic active HCV.
  • HCV-positive children have no restrictions for participation in regular childhood activities.
  • Treatment start ≥3 years of age (2),(3)

Incidence
  • Highest incidence is between 20 and 39 years of age.
  • Most common in males and non-Hispanic whites.
  • IV drug use accounts for ~60–70% of new cases.
Prevalence
  • HCV is the most common cause of chronic liver disease and transplantation in the United States.
  • HCV-related deaths are more common than HIV-related deaths.
  • Eight known genotypes (GTs) with 86 subtypes. GT 1 is the predominant form, 75% in U.S., ~46% worldwide). GT predicts response to treatment (1),(2),(4),(5).

Etiology and Pathophysiology

Single-stranded RNA virus of Flaviviridae family (5)

Genetics
  • No known predisposing genetic factors.
  • Transmission occurs primarily via parenteral exposure to infected blood

Risk Factors

  • Exposure risks
    • Chronic hemodialysis
    • Blood/blood product transfusion or organ transplantation before July 1992
    • Household or health care–related exposure
    • Children born to HCV-positive mothers
  • Other risks:
    • Prior/current history of injection drug use
    • High-risk sexual behaviors, intranasal illicit drug use
    • HIV and hepatitis B infection, history of incarceration
    • Tattooing in unregulated settings
    • Sharing personal hygiene products—razor, toothbrush, nail clippers
    • Needlestick injury in health care setting (3)

General Prevention

  • Primary prevention
    • Do not share hygiene products
    • Use clean needles and dispose of needles properly.
    • Do not share needles, cover cuts and sores
    • Practice safe sex (condoms).
  • Secondary prevention
    • No vaccine or postexposure prophylaxis available
    • Substance abuse treatment
    • Barrier contraception
    • Assess for degree of liver fibrosis/cirrhosis (3).

Commonly Associated Conditions

Extrahepatic manifestations/associated diseases (3)

  • Hepatitis B coinfection, HIV coinfection
  • Mixed cryoglobulinemia
  • HCV-related renal disease—most commonly membranoproliferative glomerulonephritis
  • Diabetes mellitus/insulin resistance
  • Dermatologic manifestations: necrotizing vasculitis, mixed cryoglobulinemia, porphyria cutanea tarda, lichen planus, erythema multiforme, erythema nodosum
  • Autoimmune conditions
  • Lymphoma—most commonly non-Hodgkin
  • Depression, substance abuse/recovery

-- To view the remaining sections of this topic, please or --

Basics

Description

Systemic viral infection involving the liver.

Epidemiology

Geriatric Considerations
Patients >60 are less responsive to therapy (1),(2)

Pregnancy Considerations

  • Routine prenatal HCV testing.
  • Vertical transmission rate is ~6/100 births; risk doubles with HIV coinfection.
  • Breastfeeding safe if no cracks or fissures (3).

Pediatric Considerations

  • Prevalence: 0.3%
  • Test children born to HCV-positive mothers.
  • 20% of infants clear HCV, 30% have chronic active HCV.
  • HCV-positive children have no restrictions for participation in regular childhood activities.
  • Treatment start ≥3 years of age (2),(3)

Incidence
  • Highest incidence is between 20 and 39 years of age.
  • Most common in males and non-Hispanic whites.
  • IV drug use accounts for ~60–70% of new cases.
Prevalence
  • HCV is the most common cause of chronic liver disease and transplantation in the United States.
  • HCV-related deaths are more common than HIV-related deaths.
  • Eight known genotypes (GTs) with 86 subtypes. GT 1 is the predominant form, 75% in U.S., ~46% worldwide). GT predicts response to treatment (1),(2),(4),(5).

Etiology and Pathophysiology

Single-stranded RNA virus of Flaviviridae family (5)

Genetics
  • No known predisposing genetic factors.
  • Transmission occurs primarily via parenteral exposure to infected blood

Risk Factors

  • Exposure risks
    • Chronic hemodialysis
    • Blood/blood product transfusion or organ transplantation before July 1992
    • Household or health care–related exposure
    • Children born to HCV-positive mothers
  • Other risks:
    • Prior/current history of injection drug use
    • High-risk sexual behaviors, intranasal illicit drug use
    • HIV and hepatitis B infection, history of incarceration
    • Tattooing in unregulated settings
    • Sharing personal hygiene products—razor, toothbrush, nail clippers
    • Needlestick injury in health care setting (3)

General Prevention

  • Primary prevention
    • Do not share hygiene products
    • Use clean needles and dispose of needles properly.
    • Do not share needles, cover cuts and sores
    • Practice safe sex (condoms).
  • Secondary prevention
    • No vaccine or postexposure prophylaxis available
    • Substance abuse treatment
    • Barrier contraception
    • Assess for degree of liver fibrosis/cirrhosis (3).

Commonly Associated Conditions

Extrahepatic manifestations/associated diseases (3)

  • Hepatitis B coinfection, HIV coinfection
  • Mixed cryoglobulinemia
  • HCV-related renal disease—most commonly membranoproliferative glomerulonephritis
  • Diabetes mellitus/insulin resistance
  • Dermatologic manifestations: necrotizing vasculitis, mixed cryoglobulinemia, porphyria cutanea tarda, lichen planus, erythema multiforme, erythema nodosum
  • Autoimmune conditions
  • Lymphoma—most commonly non-Hodgkin
  • Depression, substance abuse/recovery

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