HCV 101

HCV is the most common blood-borne infection in the United States: At least 3.8 million people have been infected.6

Previously, the blood supply was a major mode of HCV transmission, but now that the blood supply is thoroughly screened for the virus, IDU with shared, unsterilized equipment accounts for 68 percent of new HCV infections.7 HCV is also transmitted perinatally, from improperly sterilized dialysis equipment, and through unprotected sex with an infected partner. Cohort studies report that men who have sex with men (MSM) and people who have other sexually transmitted infections are at greater risk for contracting HCV from unprotected sex.8-11

Unlike HIV, HCV infections are not always chronic; some people clear the virus spontaneously (without treatment), usually within a few months after infection. That said, most people who are infected with HCV—55 to 85 percent—will develop chronic HCV infection.7,12-16

The course of HCV varies considerably, making it difficult to predict disease progression (Figures 1 and 2).

Chronic HCV infection may be asymptomatic, with minimal to no liver disease, or it may present with mild to moderate liver disease (fibrosis).17-22
An estimated 20 percent of people with chronic HCV infection will progress to cirrhosis over a 20- to 50-year interval.20-22 A greater proportion of HIV/HCVcoinfected people may progress to cirrhosis (serious liver scarring), and liver disease progression is more rapid among those who are coinfected than among those with HCV alone.23-26
Alcohol consumption, aging, and duration of HCV infection promote liver disease progression.
Each year, 1 to 5 percent of people with HCV-related cirrhosis develop hepatocellular carcinoma.27,28
In the United States, liver disease due to chronic HCV infection is the leading indication for liver transplantation.29
Annually, at least 8,000 to 12,000 deaths are attributed to complications from chronic HCV infection.26,30