Hepatitis C

Quick links

Hepatitis C virus is the most common chronic blood borne pathogen in the United States and a leading cause of complications from chronic liver disease. The prevalence of the anti-HCV antibody in the United States is approximately 1.6% in noninstitutionalized persons. According to data from 1999 to 2008, about three fourths of patients in the United States living with HCV infection were born between 1945 and 1965, with a peak prevalence of 4.3% in persons aged 40 to 49 years from 1999 to 2002. The most important risk factor for HCV infection is past or current injection drug use, with most studies reporting a prevalence of 50% or more.

The USPSTF found no direct evidence on the benefit of screening for HCV infection in asymptomatic adults in reducing morbidity and mortality. However, the USPSTF found adequate evidence that antiviral regimens result in sustained virologic response (SVR) and improved clinical outcomes.  The USPSTF concludes that screening is of moderate benefit for populations at high risk for infection. The USPSTF concludes that 1-time screening in all adults in the United States born between 18 to 79 years old is also of moderate benefit.

Historically treatment for Hepatitis C was arduous and needed to be carried out by a specialist.  Now this disease can be treated by primary care providers and the largest barrier has become the cost of the medications.  

The medications are extremely expensive and are available through the pharmaceutical companies Patient Assistance Program (see medications).

There  are links to the full guidelines for screening, treating and monitoring patients with Hepatitis C.  There is also a Hepatitis C algorithm for primary care providers to be able to follow when treating patients.  A patient can be treated for 8 weeks with many of the medication if they have no prior hcv treatment, no or compensated cirrhosis that is Child A class, and a low viral load (<6millionIU/mL).  Otherwise most medications will require 12 weeks of treatment.  Referral is warranted to GI or a hepatologist if there is evidence of cirrhosis, HIV or hepatitis B coinfection.

When interacting with patients with hepatitis C harm reduction can be just as important as a cure.