Hepatitis C: An Overview By Jose Poulose, M.D.

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Hepatitis C An Overview

• Jose Poulose, M.D

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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
  7585 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
  20102012
• Source CDC.GOV

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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

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Some more facts

• Of every 100 persons infected with HCV,
  approximately
• 7585 will go on to develop chronic infection
• 6070 will go on to develop chronic liver disease
• 520 will go on to develop cirrhosis over a
  period of 2030 years
• 15 will die from the consequences of chronic
  infection (liver cancer or cirrhosis)
• Most patients are unaware of the disease.

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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

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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

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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 nations population.
• Those born between 1945 and 1965 should be
  screened once.

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Testing

• AntiHCV 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.

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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

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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!