-The hepatitis C virus (HCV) is a single-stranded RNA virus (hepacivirus)

-HIV leads to more rapid progression of chronic hepatitis C to cirrhosis

-the most common chronic bloodborne infection in the United States

-The incubation period averages 6–7 weeks

Transmission: Primarily transmitted by parenteral route usually through use of injected drugs with needle sharing accounting for more than 40% of the cases;  rarely sexually transmitted

-Transmission via breastfeeding has not been documented.

-HCV pathogenesis (average incubation period 6-12 weeks) is mainly immune mediated, in which the liver damage is caused by cytotoxic CD8 T cells and proinflammatory cytokines.

-No immunizations are currently available for HCV infections.

Symptoms & Signs:

-Most primary infections are asymptomatic or clinically mild

-can present with jaundice, anorexia, malaise, and abdominal pain

Diagnosis

Two types of diagnostic tests are available to detect HCV infection; HCV antibodies (ELISA) and confirming by HCV RNA (RT-PCR)

-Testing for antibodies to HCV (anti-HCV) is recommended for screening of asymptomatic persons based on risk factors or exposure.

-Waxing and waning aminotransferase elevations

Treatment

-No effective treatment for acute disease

-Treatment for chronic disease includes interferon, pegylated interferon, ribavirin, or HCV direct-acting antiviral agents.

-There are four current classes of direct-acting antiviral agents (DAAs): nonstructural protein (NS) 3/4A protease inhibitors, NS5B nucleoside polymerase inhibitors, NS5B non-nucleoside polymerase inhibitors, and NS5A inhibitors.

Complications

-Alcohol abuse and smoking can influence hepatitis severity.

-HCV is a pathogenic factor in mixed cryoglobulinemia and membranoproliferative glomerulonephritis.

Prognosis

-In most patients, clinical recovery is complete in 3–6 months

-Vertical transmission is around 5% in mothers who are positive for HCV RNA.

-In contrast to HAV and HBV, most people infected with HCV (85%) develop a chronic infection. Of these, up to 70% will develop chronic liver disease; Cirrhosis occurs in up to 50% of chronically infected patients.

Prevention

-Prevention consists mainly of reduction of risk factors, including screening of blood and blood products, preventing percutaneous injuries, and reducing intravenous drug use.

1. What is the most sensitive indicator to detect HCV infection? HCV RNA by the polymerase chain reaction (PCR)
2. Is breastfeeding contraindicated in women infected with hepatitis C? No