Medicine Today Internal Medicine Webcast Series

Hepatitis C Management:

Introduction



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Chronic hepatitis C virus (HCV) infection, fatty liver disease, and hepatic drug toxicity are the most common liver problems seen in patients. Infection with HCV is the most common chronic blood-borne viral infection in North America. Presently, an estimated 3.2 million people have been infected and 2.7 million have measurable levels of viral RNA in the United States.1 The annual incidence rate is estimated at 19,000, down from a high of 380,000 infections in the 1960s, with a prevalence approaching 1.6% of the population. Viral prevalence varies among patient populations respective of gender, ethnicity, occupation, and environment.2 More than 5% of certain groups are infected.3 Although the natural history is often benign, over time 20% of chronically infected individuals will develop a serious sequela culminating in severe fibrosis, cirrhosis, end-stage liver disease, or hepatoma. The disease sequalae is not limited to the liver, as extrahepatic manifestations vary from various dermatological presentations, including lichen planus, leukocytoplastic vasculitis, to membranoproliferative glomerulonephritis, porphyria cutanea tarda, Sjogren’s, or B-cell lymphoma.

Currently, HCV infection is responsible for an estimated 8,000 to 10,000 deaths annually in the United States, and that number is predicted to triple in the next 10 to 20 years. HCV-related disease is the leading indication for liver transplantation in the United States. The substantial morbidity and mortality of HCV plus with the economic burden associated with HCV infection are responsible for the striking worldwide public health impact of this condition. Information collected from various sources show that financial expenditures will continue to escalate with an annual estimate of $25 billion by the year 2020.

It is important for all healthcare practitioners to understand effective strategies to establish or exclude a diagnosis of HCV infection and to interpret tests correctly. Effective treatment rests importantly on recognition of the attributes that influence disease progression. They include host factors such as age, obesity, comorbidities (eg, chronic renal failure, coinfection with human immunodeficiency virus [HIV]), and others. Viral properties such as genotype play an important role in treatment choices and outcomes. A thorough understanding of the pharmacology and pharmacodynamics of the agents used in treatment and management of side effects is also important. The decision to treat patients with chronic HCV infection should be made after many factors have been considered and each case has been individualized.

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