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Epidemiology, Risk Factors, and Natural History of Chronic Hepatitis C

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Chronic Viral Hepatitis

Part of the book series: Clinical Gastroenterology ((CG))

Abstract

Key Principles

Approximately 3% of the world’s population is infected with the hepatitis C virus (HCV) with the highest prevalence rates noted in Africa and Asia.

In the United States, the incidence of HCV infection is declining secondary to effective blood donor screening adopted in the early 1990s and changing practices of intravenous drug users due to an increased awareness of HIV and hepatitis.

Hepatitis C can be categorized into six genotypes and 50+ subtypes. Genotypes 1a and 1b are the most common, accounting for about 60% of global infections.

Hepatitis C is transmitted primarily via parenteral routes. Mucosal exposures to blood or serum-derived fluids and environmental sources also play a role in HCV transmission.

Controversy exists regarding the natural history of hepatitis C. While many experts view hepatitis C as a progressive disease with a high likelihood of advancing to cirrhosis, hepatocellular carcinoma, and death, others consider this virus to be more variable in nature, with the majority of patients “dying with the disease, not of the disease.” The CDC estimates that up to 20% of chronic HCV infections lead to cirrhosis over a period of 20–30 years.

Several factors influence the rate of progression of hepatitis C. Progression is hastened when acquired via blood transfusion; at an older age; in males; in non-African-Americans; in the setting of excessive alcohol (and possibly tobacco) use; and, in persons with HIV and/or HBV coinfection or features of metabolic syndrome. It is controversial if HCV viral load and genotype affect the evolution of disease.

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  1. Washington Hospital Center, Washington, DC, USA

    Nalini K. Sharma MD & Averell H. Sherker MD FRCP (C)

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  1. Nalini K. Sharma MD
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  1. Department of Hepatology, Georgetown University Hospital, Reservoir Road GUH 3800, Washington, 20007, U.S.A.

    Kirti Shetty

  2. University of Connecticut Health Center, Farmington Ave. 236, Farmington, 06030-1845, U.S.A.

    George Y. Wu

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Sharma, N.K., Sherker, A.H. (2009). Epidemiology, Risk Factors, and Natural History of Chronic Hepatitis C. In: Shetty, K., Wu, G. (eds) Chronic Viral Hepatitis. Clinical Gastroenterology. Humana Press. https://doi.org/10.1007/978-1-59745-565-7_2

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