Hepatitis C is a chronic viral infection of the liver which has been called Non A Non B hepatitis and transfusion hepatitis in the past.
Hepatitis C is an epidemic in the United States. The Center for Disease Control (CDC) estimates that during the past years a maximum of 180,000 new cases of HCV were identified. Fortunately, with screening and the development of antibody screening tests, the number of newly acquired acute hepatitis C infection has decreased. In the 1980's, 180,000 cases were identified. At present, this rate has dropped to approximately 28,000 new cases. This represents a significant decrease in the development of new cases of hepatitis C. The decrease is associated with improvement in identification of those at risk and increase physician awareness of the problem.
Hepatitis C currently infects approximately 4 million United States patients. It is responsible for 8,000 to 10,000 deaths per year. These deaths are usually secondary to hepatocellular carcinoma and other complications of HCV associated cirrhosis. Over the next 10 to 20 years, it is expected that the number of HCV associated deaths will triple. At present, hepatitis C is the most common cause for orthotopic liver transplant. Based upon the above figures, the need for liver transplantation will increase exponentially over the next two decades. This will place an increased number of patients on waiting lists for a limited number of orthotopic liver transplants. It is the goal of physicians and investigators to identify and treat patients before the development of cirrhosis. Unfortunately, only a small number of HCV cases have been confirmed despite the estimated 4 million cases present in the United States. Initial steps to prevent this dilemma are identification of patients at risk by knowing the risk factors associated with the transmission of HCV.
In general, the acute infection with HCV results in essentially no symptoms or jaundice (turning yellow). Some patients can clear the virus and develop antibodies that may be protective for the rest of their lives. Most patients develop a chronic infection that results in chronic inflammation of the liver. After 20 years, some patients will develop cirrhosis. This appears to be about 20 to 30 percent.
One of the major problems with HCV is determining how fast the damage occurs. Some patients will have rapid progression of their disease while others may harbor the disease for decades and have little or no damage to their liver.
Risk factors for Acquisition of HCV
The HCV virus is acquired through direct innoculation into the blood stream. This is the common mechanism amongst many different routes of transmission. Some patients have no identifiable risk factors. The manner in which they became infected is unclear. Some physicians have estimated this may account for up to 40% of patients.
Patients who have an increased risk for hepatitis C have a history that includes:
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History of Intravenous Drug Abuse. |
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History of tattoos. |
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History of packed red cell transfusions. |
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Hemophilia. |
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Organ transplant recipients. |
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Body piercing. |
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Persons are sexually active with > 50 separate partners in their lifetime. |
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Snorting of recreational drugs. |
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HIV-positive individuals. |
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Hemodialysis patients. |
Identification of patients who are risk for hepatitis C is based upon these historical factors. However, any patient who has elevated liver function tests, particularly ALT, should undergo screening test for hepatitis C.
Sexual transmission of the HCV virus is quite low when compared to Hepatitis B and HIV. Studies have shown that long-term monogamous relationships where one partner has HCV and the other does not remain this way for long periods of time. The rate of transmission is thought to be about 3-4% in these groups. However, higher risk activities such as anal sex, multiple sexual partners or frequenting prostitutes may increase the rate of transmission. The best possible protection is the use of the condom until the HCV positive partner can be treated and the infection eradicated.
Transmission during pregnancy is again limited. The risk of passing the virus from mother to fetus is approximately 5% It is always important to inform your gynecologist that you have HCV.
Prevention of HCV is based upon limiting the exposures described above. Family members should follow the same precautions for HCV as they would for HBV. This includes not sharing razor blades, toothbrushes etc. There is no vaccine available at present although work is underway to develop one.
If you have a history of one of the above, please contact your physician to see if you need a screening test for HCV performed.
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