Hepatitis C – Screening, Diagnosis, Management & Treatment
Hepatitis C virus (HCV) infection is a major cause of chronic liver disease, hepatocellular carcinoma and cirrhosis with at least 185 million people infected worldwide, causing 399,000 deaths annually. HCV is transmitted through blood or body fluids. Transmission most commonly occurs through sharing of injection drug, occupational exposure through needlestick injuries in healthcare settings, and birth to an HCV infected mother. There are seven known genotypes of HCV, 1a, 1b, 2, 3, 4, 5, and 6, with the most common genotypes in the U.S. being 1a, 1b, 2, and 3, which comprise approximately 97% of all U.S. HCV infections. Risks for disease progression include baseline liver histology, age, ethnicity, gender, alcohol use, comorbidities and immune response. There are multiple screening recommendations currently in place, some of which are based on risk factors, with others based on legislation. The screening test of choice is the anti-Hepatitis C virus antibody, with a confirmatory HCV RNA PCR with genotyping. Once the diagnosis is made, assessing the level of fibrosis and/or cirrhosis is an important step in determining the pathway to treatment. There are multiple new options for treatment with improved efficacy and less side effects. Patient being treated for HCV should be monitored and assessed for compliance with therapy and adverse effects, including new or worsening psychiatric illness and screened for alcohol and substance abuse. Several studies have shown the long-term outcomes with the above treatments reducing morbidity and mortality. A summary of key clinical recommendations can be found in Table 1.