Manual Handbook of Hepatitis C

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Genotype 1 is the most common and is also the most resistant to treatment. This is in contrast to acute hepatitis C virus infection, in which serum hepatitis C virus RNA clears within six months. Prospective studies have shown that 60 to 85 percent of persons infected with hepatitis C virus will develop chronic infection. This review discusses only interventions used to treat chronic hepatitis C virus infection without liver decompensation. The effect of treatment is measured by the presence or absence of detectable serum hepatitis C virus RNA.

The loss of detectable hepatitis C virus RNA at the end of the treatment period is defined as the end of treatment virologic response.


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The loss of detectable hepatitis C virus RNA 24 weeks or more after the completion of treatment is termed the sustained virologic response. Response to treatment is defined as the loss of detectable serum hepatitis C virus RNA.


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Non-response is defined as a failure to clear serum hepatitis C virus RNA during the treatment period. A relapse from treatment is defined as loss of serum hepatitis C virus RNA during treatment, which reappears during the follow-up period, typically within 24 weeks of treatment episode. Hepatitis C virus has emerged as a major viral pandemic over the past two decades, with about 3 percent of the world's population chronically infected.

Hepatitis C (Chronic)

The prevalence of hepatitis C virus varies throughout the world, with the highest number of infections reported in Egypt 6 to 28 percent. In the United States, an estimated 4 million persons are positive for hepatitis C virus antibodies, reflecting a prevalence rate of 2 percent; about 35, new hepatitis C virus infections are estimated to occur each year. In Europe, the prevalence of hepatitis C virus infection ranges from about 0.

Diagnosis of hepatitis C virus infection is often the result of active screening, because many persons with chronic infection remain asymptomatic, including a significant number of those who progress to cirrhosis. Therefore, the true incidence of hepatitis C virus is difficult to calculate accurately because it relates to the prevalence of risk factors for hepatitis C virus transmission, in particular injection drug use.

Hepatitis C virus is mainly bloodborne, and transmission occurs primarily through exposure to infected blood. This exposure may occur with injection drug use, blood transfusion or solid organ transplantation in the absence of universal screening procedures, maternal vertical transmission, unsafe medical practices, and occupational exposure to infected blood.

As a result of hepatitis C virus screening, the absolute risk of acquiring infection through blood components or products is now low—less than 1 per , units of blood transfused. Vertical transmission is uncommon, with a transmission rate of less than 6 percent. Poverty, high-risk sexual behavior, and having fewer than 12 years of education are linked to an increased risk of infection. However, no risk factors can be identified in some patients. The spectrum of liver disease and the rate of disease progression vary in persons with chronic hepatitis C virus infection.

Complications include cirrhosis, compensated and decompensated liver disease, and hepatocellular carcinoma. Factors associated with disease progression include older age at acquisition; male sex; coinfection with HIV, hepatitis B virus, or both; coexisting liver disease; and excessive alcohol consumption.

In persons who develop cirrhosis, the five-year risk of decompensation is 15 to 20 percent, the five-year risk of hepatocellular carcinoma is 10 percent, and in those who develop cirrhosis, the annual risk of hepatocellular carcinoma is 1 to 5 percent per year. Already a member or subscriber?

Log in. Adapted with permission from Mohsen A, Norris S. Hepatitis C chronic. Clin Evid Handbook. The medical information contained herein is the most accurate available at the date of publication. Want to use this article elsewhere? Get Permissions.

Read the Issue. Sign Up Now. Next: Pruritic Axillary Papules. Jun 15, Issue. Beneficial Interferon Interferon plus ribavirin Peginterferon Peginterferon plus ribavirin What are the effects of interventions to treat persons with chronic infection, but without liver decompensation, who have not responded to interferon treatment? Beneficial Interferon-alfa plus ribavirin Unknown effectiveness Interferon retreatment Peginterferon Peginterferon plus ribavirin What are the effects of interventions in persons with chronic infection, but without liver decompensation, who relapse after interferon treatment?

Clinical Questions What are the effects of interventions in treatment-naive persons with chronic infection but without liver decompensation? Definition Hepatitis C virus, identified in , is a member of the Flaviviridae family of spherical, enveloped, positive-strand RNA viruses. Incidence and Prevalence Hepatitis C virus has emerged as a major viral pandemic over the past two decades, with about 3 percent of the world's population chronically infected.

Etiology and Risk Factors Hepatitis C virus is mainly bloodborne, and transmission occurs primarily through exposure to infected blood. Prognosis The spectrum of liver disease and the rate of disease progression vary in persons with chronic hepatitis C virus infection. Read the full article. Get immediate access, anytime, anywhere. In addition to these technological innovations, there have been advances in the mode of delivery of testing, so that promising new technologies reach target populations.

Supply chain management is one of the major challenges in healthcare delivery in low-income rural settings where there is limited access to laboratories or any form of diagnostic testing. Although assays for use at POC can help increase access to hepatitis testing, such decentralization of testing can also place major stresses on already fragile health systems.

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Diagnosis of viral hepatitis : Current Opinion in HIV and AIDS

Unmanned aerial vehicles UAVs , also referred to as drones, are remotely operated robotic airplanes that have emerged as a potentially valuable technology to deliver healthcare supplies, such as RDTs, DBS specimens, blood products and vaccines, to remote locations with poor transport routes, especially during the rainy season [53]. UAVs can carry a payload of 2—3 kg sufficient for RDTs , fly a distance of approximately 60 km and either land or do aerial drops of their payload onto a target area.

A further priority is to address key research gaps that will in turn inform future global guidance on viral hepatitis testing in LMICs. This can take the form of comparative trials, large-scale implementation studies or demonstration projects in a range of epidemic settings and populations in LMICs. To overcome current challenges in hepatitis testing and substantially increase awareness of hepatitis status and earlier diagnosis, there is a need to provide a secure supply of quality-assured affordable diagnostics, services that can reach those populations most affected, well functioning laboratories to ensure high-quality testing and treatment monitoring, an appropriately trained health workforce and active involvement of affected communities.

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The new WHO global testing guidelines provide a major opportunity to improve identification and treatment of persons with CHB and HCV infection, and achieve the Global Health Sector Strategy on viral hepatitis targets on testing and treatment. This will, in turn, improve clinical outcomes, save lives and reduce hepatitis B and C transmission. Advances in hepatitis virus detection technology have created new opportunities for enhancing testing referral and treatment, with simplified one-assay testing algorithms, use of POC molecular tests, multiplex or polyvalent testing, self-testing and new modes of service delivery.

Many professionals from a range of backgrounds and specialties have contributed to the development of this guidance. WHO is sincerely grateful for their time and support. The opinions expressed are those of the author s and do not necessarily represent those of the organization. There are no conflicts of interest. Papers of particular interest, published within the annual period of review, have been highlighted as:. This systematic review provides updated regional and global estimates of prevalence and burden of chronic hepatitis B infection.

This systematic review and meta-analysis provides new regional and global estimates of prevalence and burden of HIV—HCV coinfection in five different population groups.

Hepatitis C in Canadian Immigrants and Newcomers

First global strategy on hepatitis that sets out a series of impact and service delivery targets as well as priority actions for countries and WHO to achieve these. New evidence-based global guidelines on who to test and how to test for chronic hepatitis B and C, and strategies for implementation. Website provides updated information on status of quality assessments of hepatitis B and C assays for WHO prequalification. You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page. Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent.

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