Hepatitis C Committee

Chair: Dr. P. Kishore, MD, MPH, CMA
(Boston NAMA)

Committee Members
Paul Bowman, CMA 

Cheri Jarvis, CMA 

Hepatitis C

Hepatitis is an inflammation of the liver. Although in many people the diseased liver is able to repair itself and regain function, it may progress to scarring of the liver and chronic liver disease. Hepatitis can have numerous causes. A common cause is infection with one of the several types of viruses (e.g., hepatitis A, B, or C viruses).

Hepatitis C virus (HCV) infection occurs when blood, or other body fluids from an infected person enters the body of an uninfected person. In 2000, about 30,000 new infections occurred. Most of these infections occurred among young adults 20-39 years old. Injection drug use and blood transfusion prior to 1992 are major risk factor for HCV infection. About 3.9 million American have been infected with HCV and 2.7 million have chronic infection. In 2000, about 30,000 new infections occurred. Most of these infections occurred among young adults 20-39 years old.

HCV infection is becoming a leading cause of cirrhosis. In addition to genetic factors in the infected person three independent factors are associated with an increased rate of disease progression. These factors include daily alcohol consumption, age at infection of more than 40 years, and male gender. These factors have a greater influence on progression to cirrhosis in HCV infection than the virus itself.

Risk Factors for Hepatitis C Virus infection are:

1. Intravenous drug use- Current or remote intravenous drug use accounts for 50% of new cases of HVC; 50% to 60% infected with HCV within 3 months of initiation of injection behavior
2. Intranasal cocaine- Risk factor suggested by epidemiologic evidence
3. Tattooing – Remains controversial as a risk factor
4. Health care workers – Risk for JCV infection is fourfold that of blood donors; for needlestick injury, seroconversion rate is approximately 2%
5. Transfusion of blood products – With modern screening. Risk for HCV transmission is estimated at 0.01% to .0.001 % per unit transfused
6. Hemodialysis -U.S patients receiving hemodialysis have 10% to 20% prevalence of chronic HCV infection
7. Sexual transmission- Estimated risk is 1% to 3% over lifetime of a monogamous relationship; barrier methods deed unnecessary in monogamous couples
8. Vertical transmission- Estimated risk is approximately 5% per exposure; testing of infants not recommended before 1 year of age; breast feeding considered low risk

Chronic hepatitis C virus infection is common and often asymptomatic. Antibodies against HCV are a highly sensitive marker of infection. Molecular testing for HCV is used to confirm a positive result on antibody testing and to provide prognostic information for treatment; however, quantitative HCV RNA does not correlate with disease severity or risk for progression. Chronic HCV infection is most frequently associated with remote or current intravenous drug use and blood transfusion before 1992, although as many as 20%of infected patients have no identifiable risk factor. In an estimated 15% to 20% of persons infected with HCV, the infection progresses to cirrhosis; alcohol intake is an important factor in this progression. Most specialists prefer to include an examination of a liver biopsy in the management of patients with chronic HCV infection to aid prognostic and treatment decisions. The current standard of pharmacologic treatment of chronic HCV is weekly subcutaneous peginterferon in combination with daily oral ribavirin, which results in sustained virologic response in approximately 55% of chronically infected patients. Side effects of interferon therapy include myalgias, fever, nausea, irritability, and depression. The primary care physician and gastroentrologist serve a vital role in identifying patients with chronic HCV infection, educating patients with chronic HCV infection, educating patients about risk factors for transmission, advising patients about the avoidance of alcohol, and aiding patients in making treatment decisions.