Hepatitis C: An OverviewJOSE POULOSE, M.D

Some facts

An estimated 2.7-3.9 million people in the United States have chronic hepatitis C.

 An estimated 30,500 acute hepatitis C cases occurred in 2014. HCV infection becomes chronic in approximately 75%–85% of cases. In 2014, a total of 2,194 cases of acute hepatitis C were reported to

CDC from 40 states. The overall incidence rate for 2014 was 0.7 cases per 100,000

population, an increase from 2010–2012*Source: CDC.GOV

Who is at risk?

Current or former injection drug users, including those who injected only once many years ago

Recipients of clotting factor concentrates made before 1987, when more advanced methods for manufacturing those products were developed

Recipients of blood transfusions or solid organ transplants before July 1992, when better testing of blood donors became available

Chronic hemodialysis patients Persons with known exposures to HCV, such as

health care workers after needlesticks involving HCV-positive blood recipients of blood or organs from a donor who tested HCV-positive

Persons with HIV infection Children born to HCV-positive mothers

Some more facts:

Of every 100 persons infected with HCV, approximately 75–85 will go on to develop chronic infection 60–70 will go on to develop chronic liver disease 5–20 will go on to develop cirrhosis over a period of 20–30 years 1–5 will die from the consequences of chronic infection (liver cancer or

cirrhosis) Most patients are unaware of the disease.

How is it transmitted?

Injection drug use (currently the most common means of HCV transmission in the United States)

Receipt of donated blood, blood products, and organs (once a common means of transmission but now rare in the United States since blood screening became available in 1992)

Needle stick injuries in health care settings Birth to an HCV-infected mother ex with an HCV-infected person (Less frequent) Sharing personal items contaminated with infectious blood, such as razors or

toothbrushes-Very unusual (Other health care procedures that involve invasive procedures, such as

injections

Who should be screened?

Currently injecting drugs Ever injected drugs, including those who injected once or a few times many years ago Have certain medical conditions, including persons:

who received clotting factor concentrates produced before 1987 who were ever on long-term hemodialysis with persistently abnormal alanine aminotransferase levels (ALT) who have HIV infection

Were prior recipients of transfusions or organ transplants, including persons who: were notified that they received blood from a donor who later tested positive for HCV infection received a transfusion of blood, blood components, or an organ transplant before July 1992

HCV- testing based on a recognized exposure is recommended for: Healthcare, emergency medical, and public safety workers after needle sticks, sharps, or

mucosal exposures to HCV-positive blood Children born to HCV-positive women

Baby Boomers and Hepatitis C screening

Almost exactly nine months after World War II ended, “the cry of the baby was heard across the land,” as historian Landon Jones later described the trend. More babies were born in 1946 than ever before: 3.4 million, 20 percent more than in 1945. This was the beginning of the so-called “baby boom.” In 1947, another 3.8 million babies were born; 3.9 million were born in 1952; and more than 4 million were born every year from 1954 until 1964, when the boom finally tapered off. By then, there were 76.4 million “baby boomers” in the United States. They made up almost 40 percent of the nation’s population.

Those born between 1945 and 1965 should be screened once.

Testing:

Anti–HCV antibody testing followed by polymerase chain reaction testing for viremia is accurate for identifying patients with chronic HCV infection. Various noninvasive tests with good diagnostic accuracy are possible alternatives to liver biopsy for diagnosing fibrosis or cirrhosis.

Early detection has shown to be effective in altering the natural course of the disease.

Screening should be done voluntarily and with the patient clearly understanding that they are being screened.

Symptoms:

Most people have no symptoms. Those who do develop symptoms may have fatigue, nausea, loss of appetite, and yellowing of the eyes and skin.

but people may experience: Pain areas: in the abdomen Gastrointestinal: bleeding, bloating, fluid in the abdomen, or nausea

Whole body: fatigue, fever, or loss of appetite Skin: web of swollen blood vessels in the skin or yellow skin and eyes

Also common: depression or weight loss

Medications:

Antiviral drug: Reduces viruses' ability to replicate. Interferon alfa-2b (Pegintron) Pegylated interferon alfa Sofosbuvir (Sovaldi) Ribavirin (Rebetol, Copegus, Virazole, and Ribasphere) Simeprevir (Olysio) Ledipasvir*Always remember: Prevention is better than cure! Say goodbye to those shared needles! Get yourself checked!