Hepatitis C virus (HCV) infection is the most common chronic bloodborne infection in the United States. During the 1980s, an average of 242,000 new infections occurred every year. However, with the advent of new tests for HCV, the annual number of new infections has declined by >80 percent to 36,000 by 1996. An estimated 3.9 million (1.8 percent) Americans have been infected with HCV. 75-85 percent of these persons are chronically infected and may not be aware of their infection due to a lack of clinical symptoms. However, infected persons can serve as a source of transmission to others and are at risk for chronic liver disease or other HCV-related chronic diseases during the first two or more decades following initial infection.
Chronic liver disease is the tenth leading cause of death among adults in the United States, and accounts for approximately 25,000 deaths annually. It is estimated from population-based studies that 40 percent of chronic liver disease is HCV-related, resulting in an estimated 8,000–10,000 deaths each year. HCV- associated end-stage liver disease is the most frequent indication for liver transplantation among adults. Because most HCV-infected persons are aged 30–49 years, the number of deaths attributable to HCV-related chronic liver disease could increase substantially during the next 10–20 years as this group of infected persons reaches ages at which complications from chronic liver disease typically occur.
HCV is transmitted primarily through large or repeated direct percutaneous exposures to blood. In the United States, the relative importance of the two most common exposures associated with transmission of HCV, blood transfusion and injecting-drug use, has changed over time. Blood transfusion, which accounted for a substantial proportion of HCV infections acquired >15 years ago, rarely accounts for recently acquired infections although the risk is not zero. In contrast, injecting-drug use consistently has accounted for a substantial proportion of HCV infections and currently accounts for 60 percent of HCV transmission in the United States and a high proportion of infections continue to be associated with injecting-drug use.
Finally, in order to reduce the burden of HCV infection and HCV-related disease in the United States, primary prevention activities to reduce the risk for contracting HCV infection and secondary prevention activities to reduce the risk for liver and other chronic diseases in HCV-infected persons must be implemented. These programs must be supported by the medical community and the general population.
Hepatitis C physician toolkit now available!
The AMA is collaborating with the Centers for Disease Control and Prevention's (CDC) Division for Viral Hepatitis to distribute and evaluate a physician toolkit on management of Hepatitis C.