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More on Hepatitis C

Hepatitis-CHepatitis C virus (HCV) is the most common chronic blood-borne disease and the leading cause of liver transplantation in the U.S., affecting an estimated 3.2 million Americans. Recent advancement in antiviral treatment options has significantly increased the response rates to anti-HCV therapy even among the difficult to treat populations.

Despite this, it is estimated that only 34–48% of chronic carriers are referred for liver specialist assessment, and less than 37% of patients receive treatment for hepatitis C.

Uninsured and under-insured patient populations with limited access to care are especially at risk. The virus can stay dormant for years, and transpire through visible symptoms when patients get older and when treatment becomes more complicated and harder on the patient’s quality of life for extended period of time.

Middle-aged and older adults born between 1945 and 1965 as well as homeless and incarcerated adults are at increased risk for infection. In a study of over 400 homeless war veterans, the prevalence of HCV infection was 44.0% (Desai RA, Rosenheck RA, Agnello V, et al. Prevalence of hepatitis C virus infection in a sample of homeless veterans. Soc Psychiatry Psychiatr Epidemiol. 2003;38:396-401). The most significant risk factor for chronic HCV infection is prior injection drug use.

Evidence of HCV infection is twice as common among women than men and among African Americans than white adults. The most important risk factor for HCV infection is intravenous drug use. Other significant risk factors for HCV infection include receipt of blood transfusion before 1992, receipt of other blood products before 1987, and other drug use.

Sexual behavior is a less powerful risk factor HCV infection compared with HIV infection, but there is evidence that a history of multiple sexual partners is associated with a higher risk for HCV infection. Many individuals with HCV infection have overlapping risk factors for infection.

Therefore, in additional to regular screening among high-risk groups, the US Preventive Services Task Force (USPTSF) now recommends 1-time screening for chronic HCV infection for adults born between 1945 and 1965.

Early detection via relatively simple blood testing could help doctors monitor the virus better and offer efficacious treatment at a younger age – with good results and with less harm to the patient.

The following assays are used for diagnosing and managing Hepatitis C (HCV) infection:

  1. Serologic assays: These detect a specific antibody to the hepatitis C virus (anti-HCV) in the serum or plasma and are reported as a positive or a negative value.
  2. Molecular assays: These detect viral nucleic acid and can be qualitative or quantitative. Quantification of the virus is reported using international units per milliliter (IU/mL).
  3. Genotyping assays: These are most useful in epidemiological studies and are clinically used to predict the likelihood of response and duration of therapy; they help to classify the virus into the 6 major genotypes.

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