Hepatitis C

Basics

Description

Systemic viral infection involving the liver

Epidemiology

Geriatric Considerations

  • Patients >60 years of age may be less responsive to therapy (1).

Pregnancy Considerations

  • Routine prenatal hepatitis C virus (HCV) testing
  • For HCV-infected mothers, retest HCV RNA postpartum to evaluate for spontaneous clearance.

Pediatric Considerations

  • Test children born to HCV-positive mothers (ideally at 2 to 6 months of age).
  • Treatment starts ≥3 years of age (1).

Incidence

  • Incidence of acute hepatitis C has more than doubled since 2013.
  • IV drug use accounts for ~60–70% of new cases.
  • Universal screening now recommended for all adults (at least once); annual screening for high-risk groups

Prevalence

  • HCV is the most common bloodborne infection in the United States.

Etiology and Pathophysiology

  • Enveloped, single-stranded RNA virus
  • Seven known genotypes (GT) with 86 subtypes
  • GT 1 is the predominant form in US (1).

Genetics

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

Risk Factors

  • IV drug use, HIV infection, chronic hemodialysis
  • Blood/blood product transfusion or organ transplantation before July 1992
  • Household or health care–related exposure
  • Children born to HCV-positive mothers

General 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).

Commonly Associated Conditions

  • Hepatitis B coinfection, HIV coinfection
  • Mixed cryoglobulinemia
  • HCV-related renal disease—most commonly membranoproliferative glomerulonephritis

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