inPractice Hepatology

  • Editor in Chief: Stefan Zeuzem, MD

    1. 3-1

      Hepatitis C Virus Epidemiology, Pathogenesis, Diagnosis, and Natural History

      • Authors: Francesco Negro, MD;

      • Last Reviewed: 5/23/2018

      • Abstract: The current global burden of hepatitis C virus (HCV) infection is high, with an ... (more)

        Abstract: The current global burden of hepatitis C virus (HCV) infection is high, with an estimated 71 million individuals with chronic infection.[WHO 2017] Within the United States, it is estimated that approximately 3.5 million people are infected with HCV and the estimated number of new cases in 2015 was approximately 33,900, a number that has increased since 2010, especially among young white individuals residing in nonurban regions.[CDC 2015] The number of deaths from HCV increased to 19,629 in 2015[CDC 2015] and by 2007 had overtaken HIV/AIDS as a cause of death in the United States.[Ly 2012] This mortality is expected to increase, as those infected by transfusion before HCV testing become apparent.[Blatt 2004] Although improved screening of the blood supply has substantially reduced the incidence of HCV infection in the United States during the last 2 decades, the burden of infection continues to increase as a result of slowly progressing HCV-mediated liver disease, including advanced fibrosis, cirrhosis, and hepatocellular carcinoma, among patients initially infected several decades ago. Continued assessment of the evolving epidemiology of HCV infection and careful monitoring of changes in transmission trends are critical to continue to reduce the incidence of new infections. In addition, a clear understanding of the pathogenesis and natural history of the disease, including the effects of host, viral, and environmental factors on the risk of liver disease progression, is essential for optimizing management strategies for infected patients. In this module, Francesco Negro, MD, provides an in-depth review of past and current HCV transmission trends, the latest understanding of HCV pathogenesis, key assays and recommendations for the diagnosis of HCV, and the natural history of both acute and chronic HCV infection. ( less )

    2. 3-2

      Management of Hepatitis C Infection

      • Authors: Jordan J. Feld, MD, MPH; Hemant Shah, MD, MScCH HPTE;

      • Last Reviewed: 7/24/2018

      • Abstract: In patients with chronic hepatitis C virus (HCV) infection, the goal of therapy ... (more)

        Abstract: In patients with chronic hepatitis C virus (HCV) infection, the goal of therapy is virologic cure. Eradication of HCV RNA, which remains undetectable long term off therapy, is referred to as a sustained virologic response. In general, all patients with chronic HCV infection should be considered as treatment candidates. There are 4 main classes of direct-acting antiviral agents: protease inhibitors, nucleotide polymerase inhibitors, nonnucleotide polymerase inhibitors, and non–structural protein 5a (NS5A) inhibitors, which can be used in various combinations for differing durations depending on the viral genotype/subtype and the severity of liver disease. Peginterferon can be avoided in all clinical scenarios whereas ribavirin is used to enhance treatment efficacy in more challenging patient populations. The choice of regimen, the duration of therapy, and response rates are influenced by a range of host and viral factors, including baseline comorbidities, HCV genotype, HCV RNA, baseline resistance associated variants (RAVs), cirrhosis status, and treatment history. Antiviral treatment of patients with acute HCV infection significantly reduces the risk of developing chronic infection. In this module, Jordan J. Feld, MD, MPH, and Hemant Shah, MD, MScCH HPTE, describe recommendations on the management of patients with HCV infection. ( less )

    3. 3-3

      Hepatitis C Management in Special Populations

      • Authors: Mark S. Sulkowski, MD;

      • Last Reviewed: 8/17/2018

      • Abstract: HCV is a leading cause of cirrhosis and hepatocellular carcinoma across the glob... (more)

        Abstract: HCV is a leading cause of cirrhosis and hepatocellular carcinoma across the globe. With 71 million people estimated to be chronically infected worldwide and approximately 399,000 HCV-related deaths each year, HCV is a substantial public health concern. In the United States, HCV is a leading cause of death from liver disease and is the most common indication for a liver transplantation. Although HCV is a widespread health problem, disease management is particularly challenging in several key subpopulations, including persons who inject drugs, patients with renal disease or HIV coinfection, children and adolescents, and liver transplantation recipients. This continuing medical education–certified module reviews the transmission, prevalence, and natural history of HCV infection in these populations and provides an in-depth analysis of how HCV treatment must be tailored for these patients. ( less )