Hepatitis C

Hepatitis C is inflammation of the liver caused by a bloodborne pathogen, the hepatitis C virus (HCV). Hepatitis C is only one of many viruses of the hepatitis family that causes viral liver disease; others include hepatitis A, B, D, and E. HCV causes both acute hepatitis, characterized by jaundice, fatigue, abdominal pain, and loss of appetite, as well as long-term liver diseases such as liver cancer and cirrhosis. Symptoms generally appear after an incubation period of 15 to 150 days, although the majority (70 percent) of those infected are asymptomatic. Chronic infection occurs in approximately 55 to 85 percent of infected persons, and about one to five percent of those chronically infected will eventually die from chronic liver diseases. In countries where liver transplants are available, cirrhotic HCV patients often represent the majority of recipients of donated livers. Patients infected with HCV are often also infected with HIV or hepatitis B, both of which can worsen HCV disease prognosis, as can high alcohol consumption.

Transmission of HCV is via direct contact with infected blood, and transmission is often a result of contaminated blood transfusions, the use of contaminated syringes, or contaminated circumcision, tattooing, or piercing equipment. Sharing of syringes among intravenous drug injectors in prisons has led to outbreaks. Patients on kidney dialysis, transplant recipients, and hemophiliacs have also been infected in the past. Sexual transmission is possible, although rarer, and transmission rates are enhanced when individuals are coinfected with other sexually transmitted diseases or are sexually assaulted. Healthcare workers face a risk of infection from workplace injuries. The virus can also be transmitted from a mother to a baby during childbirth in approximately 4 percent of cases, although the transmission probability rises if a mother is coinfected with HIV. Hepatitis C is not spread via casual contact, sneezing, coughing, breastfeeding, food, or water, although it can be spread via sharing common items such as razors and toothbrushes if they contain contaminated blood.

Globally, approximately 170 million people are infected with hepatitis C, and thus it statistically affects about four to five times as many people as [Page 830]those currently infected with HIV. Approximately three to 4 million new infections occur annually. Individuals are often coinfected with HIV or hepatitis

B. Areas of the world with the highest prevalence rates include Africa, southeast and eastern Asia, and the eastern Mediterranean region. Countries that have a larger-than-average reservoir of chronically infected HCV patients, such as Italy, Pakistan, Egypt, and Japan, often have a history of widespread injection-based prophylaxis treatments against other infectious diseases, suggesting that sterilization of injection equipment is essential when implementing population-based vaccination and treatment programs. Public awareness of the disease is often not as high as of other infectious diseases, such as HIV, and as patients are often asymptomatic, even those infected are often not aware of their illness until they present with long-term liver complications. Medical awareness of HCV is also lower than for HIV, and many patients at high risk of HCV infection go undetected even by medical personnel.

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