Hepatitis C of Homeless Persons – Part I

published in: Health Conditions & Concerns // Viral Disease

Hepatitis C of Homeless Persons - Part I
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The hepatitis C virus (HCV) was identified in 1989 and found to account for the majority of those patients with “non-A A, non-B hepatitis”. HCV is now the most common

Hepatitis C
Pedro Jose Greer, MD

T

he hepatitis C virus (HCV) was identified in 1989 and found to account for the majority of those patients with "non-A, non-B hepatitis". HCV is now the most common blood-borne infection in the USA and a leading cause of chronic liver disease. Almost 4 million Americans have been infected with HCV, and 2.7 million are chronically infected. Many of those who are chronically infected are unaware because they have no signs or symptoms. By conservative estimates, 35,000 new hepatitis C infections occur each year in the USA. The world wide burden of chronic hepatitis C infection is estimated to range from 140-170 million individuals.
Hepatitis C is a small enveloped RNA virus belonging to the Flaviviridae family and the genus hepacivirus. HCV replicates rapidly in the liver and has marked sequence heterogeneity with 6 genotypes and over 90 subtypes. In the USA, 75% of individuals infected with HCV have genotypes 1a and 1b, 15% have genotypes 2a and 2b, and 7% have genotype 3. Genotype 1a is common in Europe, while 1b is found frequently in southern Europe and around the world. Genotypes 2a and 2b are common in Italy, North Africa, and Spain. Genotype 3 is common in Northern Europe. After infection with HCV, 55-85% of individuals fail to clear the virus and develop chronic hepatitis C infection. This infection is usually asymptomatic, although persistent or fluctuating elevations in the liver enzyme ALT are common. However, 30-40% of persons with chronic HCV infection will have normal ALT levels. The consequential hepatic sequelae of hepatitis C include progressive hepatic fibrosis, cirrhosis, and hepatocellular carcinoma. The extra-hepatic manifestations include sicca syndrome, cryoglobulinemia, glomerulonephritis, porphyria cutanea tarda, as well as all the extrahepatic manifestations of chronic liver disease. Transmission The known risk factors for infection with HCV have evolved as understanding of the pathogenesis has progressed. Blood transfusions received before 1991 accounted for a substantial portion of those infected prior to that time. Improved testing of blood supplies has resulted in a dramatic decline in the number of new HCV infections due to transfusions. Rather, intravenous drug use (IVDU) now accounts for 60% and sexual exposure for 20% of new HCV infections. Occupational exposure, hemodialysis, household contacts, and perinatal
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Cheryl Kane, a nurse on BHCHP’s Street Team, brings medication to a man living under a bridge near the Charles River. Photo by Stan Grossfeld

The Health Care of Homeless Persons – Part I – Hepatitis C



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