Hepatitis C
Table of Contents
Hepatitis A · Hepatitis
B · Hepatitis C · Hepatitis
of Unknown Etiology
Hepatitis Main Page
What is Hepatitis C?
Hepatitis C is a virus that causes acute and chronic hepatitis. Over 80% of persons who acquire hepatitis C develop chronic hepatitis. The virus is transmitted by sharing needles during injecting drug use, transfusion of blood products prior to 1989 (since then, all blood donors have been screened for hepatitis C), sharing straws when cocaine is being snorted, sharing toothbrushes or razors, and tattooing with unsterile needles. Sexual transmission is also possible. Persons who are chronically infected with hepatitis C are at an increased risk for the development of cirrhosis and liver cancer. No effective vaccine has been developed to prevent hepatitis C. Only one antiviral medication has been shown to be effective in the treatment of hepatitis C. Alpha-2-interferon and ribavirin combination is licensed for the treatment of hepatitis C, but only about 30% to 50% of persons treated recover completely from this infection. The cost of treatment ranges from $15,000 to $25,000 and the toxicity from this therapy is significant.
Hepatitis C virus (HCV) is a significant cause of morbidity and mortality in the United States and many parts of the world. Studies have found a prevalence of hepatitis C to be approximately 2% in the general U.S. population. HCV has also a cause of hepatocellular carcinoma (HCC). More importantly, HCC has is a cause of end-stage cirrhosis, occurring in 5% to 30% or those infected, and in the U.S., HCV-associated cirrhosis is the number one reason for liver transplant. In Alaska Natives, HCV-associated cirrhosis is the primary reason for referral for liver transplant. The Alaska Native Medical Center (ANMC) laboratory has identified over 1300 persons who are positive for anti-HCV.
Perspective
HCV is an important cause of morbidity and mortality in the United States and many other parts of the world. The prevalence of hepatitis C in the general U.S. population is 1.8%. HCV has also a cause of HCC. More importantly, HCC is a cause of end-stage cirrhosis. In the United States, HCV-associated cirrhosis is the number-one reason for liver transplant. In Alaska Natives HCV-associated cirrhosis is also the prime reason for referral for liver transplants. ANMC laboratory has identified over 1300 persons who are positive for anti-HCV.
In collaboration with the Indian Health Service (IHS) and the University of Washington Molecular Biology Laboratory, AIP is studying the outcome of HCV in Alaska Natives. The risk factors associated with acquiring HCV and the factors associated with the progression of liver disease are being examined. These factors relate both to host and to the infecting microorganism. The investigation of the HCV virus includes such properties as the viral genotype and the level of virus in the blood. To enable this investigation, a retrospective serum bank search is being performed for consenting patients. The earliest and most recent sera samples that are positive for anti-HCV are sent for testing for HCV-RNA and genotype. In addition, a prospective analysis of patients with HCV will be performed to determine the rate of development of complications such as cirrhosis and hepatocellular carcinoma. Finally, persons with HCV who might benefit by currently licensed anti-viral therapy are being identified as part of this study and offered licensed antiviral therapy. Currently over 800 persons are enrolled in this study.
Control Program
- With the development of technology to identify the HCV virus serologically, the role of HCV in liver disease and HCC in Alaska Natives is being clarified. In addition, the prevalence of HCV in 6 villages in rural Alaska has been studied. Collaborative studies are being developed to determine the outcome of HCV in infected Alaska Natives.
Accomplishments
- Transferred the anti-HCV testing capabilities to the Alaska Native Medical Center.
- Aided the Alaska Native Medical Center in the Hepatitis C Outcome Study and have coordinated laboratory testing with the University of Washington Molecular Biology Laboratory.
- Aided the Alaska Native Medical Center in the development of a molecular biology laboratory to facilitate clinical management and research in hepatitis C.
- Provided consultation ANMC Viral Hepatitis Program for a general Lookback public health project of patients transfused at ANMC between 1980 and 1992, at the neonatal ICU at Providence Hospital from 1976-1992, and of Alaska Natives who received a blood transfusion prior to 1992 during cardiac surgery performed outside of Alaska.
Future Plans
- Evaluate results from all studies to determine what control efforts, if any, are warranted or possible.
- Continue to recruit for the outcome study.
- Continue to be involved in molecular testing for HCV.
- Analyze risk factors, viral genotypes, and incidence of HCC and end-stage liver disease in Alaska Natives with hepatitis C.
- Continue to provide consultation for the public health general Lookback project
