Hepatitis C

Hepatitis C (HCV) is a major blood-borne human pathogen affecting approximately 3% of the global population. The most important route of transmission in developed countries is injection drug use. If untreated, most acute infections progress to chronic infection and liver disease. Progression to advanced liver disease and liver cancer is influenced by several cofactors, the most important being alcohol abuse and fatty liver. Approximately one third of all adult elective liver transplantations carried out each year are performed on patients with complications of HCV infection. HCV infection is a major public health issue that deserves to be tackled with strong policy interventions aimed at identifying and effectively treating HCV-infected patients to reduce the future burden of disease.

The 5 key modes of HCV transmission include iatrogenic transmission, injection drug use, sexual transmission, mother-to-child transmission, and occupational exposure. Screening of all blood donors for anti-HCV antibodies has virtually eliminated post-transfusion HCV infection. Several effective strategies exist for reducing harm associated with drug use. Programs allowing needle exchange and syringe access without a medical prescription have proven effective in reducing HIV prevalence.

Current CDC and US Preventive Services Task Force and AASLD-IDSA guidelines recommend that all adults born between 1945 and 1965 receive one-time testing for HCV infection without previous ascertainment of HCV risk. Anti-HCV screening in other populations should be based on risk assessment, with one-time HCV testing recommended for all individuals with a history of illicit injection drug use, intranasal illicit drug use, history of long-term hemodialysis, receiving a tattoo in an unregulated facility/setting, healthcare workers upon accidental exposure, children born to anti-HCV–positive mothers, history of transfusion with blood or organ transplantation, including persons who: were notified that donor subsequently had a positive HCV test, received transfusion or transplant before July 1992, were administered clotting factor concentrates manufactured before 1987, were ever in prison, HIV infection, chronic liver disease/hepatitis with unknown cause, including elevated liver enzymes.

The goal of antiviral therapy for patients with hepatitis C virus (HCV) is virologic cure. Eradication of HCV RNA, which remains undetectable long term off therapy, is referred to as a sustained virologic response and is now an increasingly achievable prospect thanks to the availability of direct-acting antivirals. A series of investigational agents are currently in late-stage clinical development across existing and novel drug classes. It is anticipated that additional agents will be approved for the treatment of chronic HCV infection in 2014 or early 2015.

Physicians at Specialists in Gastroenterology (SIG) have been treating hepatitis C for over 20 years. Cure of hepatitis C is a reality. SIG has treated and cured almost 100 patients with hepatitis C over the year. They are confident with the new drug regimens that are currently available that the number of patients with hepatitis C who are cured will skyrocket.