Risk Factors for HCV

HCV Info Fact

24 August 2003

The 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 HCV 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.

Info Facts are prepared by the HCV Committee and under the direction of Dr. Kishore.