Hepatitis C: Updated Guidelines and New Drugs
Hepatitis C: Updated Guidelines and New Drugs
Hepatitis C infection is a disease of the liver caused by exposure to the hepatitis C virus (HCV), resulting in inflammation. The signs and symptoms of HCV infection range in severity, and the infection can be either acute or chronic. Acute HCV infection lasts up to 6 months. Symptoms of acute infection can include fever, fatigue, diminished appetite, nausea, vomiting, abdominal pain, dark urine, gray-colored feces, joint pain, and jaundice. However, up to 80% of patients exhibit no symptoms. Chronic HCV is a long-term infection that may eventually lead to cirrhosis or hepatic carcinoma. Up to 3.2 million persons in the United States alone are infected with HCV, and most do not realize that they are infected owing to the lack of symptoms.
HCV is a bloodborne virus. It is commonly transferred through sharing of needles, inadequate sterilization of medical equipment (syringes and needles), transfusion of unscreened blood and blood products, and, less commonly, through sexual transmission or transmission from mother to baby.
Diagnosing the disease requires two steps. First, patients are screened for the anti-HCV antibodies with serologic tests to identify whether the virus is in the body. If the antibody test is positive, the next step is a nucleic acid test for HCV RNA to confirm chronic HCV infection. This step is necessary because the immune system of a patient who was acutely infected may have cleared the virus, although anti-HCV antibodies remain. If chronic HCV is confirmed, liver testing and genotyping should ensue. Such testing will help determine the degree of liver damage and serve as a guide to treatment. There are six different genotypes for HCV, with genotype 1 being the most common; all respond differently to therapy.
With the advances in HCV therapy that have recently occurred, the aim of this review is to highlight the changes to the standards of practice as well as to describe the new drug options available.
Hepatitis C Virus Infection
Hepatitis C infection is a disease of the liver caused by exposure to the hepatitis C virus (HCV), resulting in inflammation. The signs and symptoms of HCV infection range in severity, and the infection can be either acute or chronic. Acute HCV infection lasts up to 6 months. Symptoms of acute infection can include fever, fatigue, diminished appetite, nausea, vomiting, abdominal pain, dark urine, gray-colored feces, joint pain, and jaundice. However, up to 80% of patients exhibit no symptoms. Chronic HCV is a long-term infection that may eventually lead to cirrhosis or hepatic carcinoma. Up to 3.2 million persons in the United States alone are infected with HCV, and most do not realize that they are infected owing to the lack of symptoms.
HCV is a bloodborne virus. It is commonly transferred through sharing of needles, inadequate sterilization of medical equipment (syringes and needles), transfusion of unscreened blood and blood products, and, less commonly, through sexual transmission or transmission from mother to baby.
Diagnosing the disease requires two steps. First, patients are screened for the anti-HCV antibodies with serologic tests to identify whether the virus is in the body. If the antibody test is positive, the next step is a nucleic acid test for HCV RNA to confirm chronic HCV infection. This step is necessary because the immune system of a patient who was acutely infected may have cleared the virus, although anti-HCV antibodies remain. If chronic HCV is confirmed, liver testing and genotyping should ensue. Such testing will help determine the degree of liver damage and serve as a guide to treatment. There are six different genotypes for HCV, with genotype 1 being the most common; all respond differently to therapy.
With the advances in HCV therapy that have recently occurred, the aim of this review is to highlight the changes to the standards of practice as well as to describe the new drug options available.
