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: 10/30/2020

      • Abstract:

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

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        Abstract:

        The current global burden of hepatitis C virus (HCV) infection is high, with an estimated 71 million individuals with chronic infection. Within the United States, it is estimated that approximately 2.4 million people are infected with HCV and the estimated number of new cases in 2017 was approximately 44,700, a number that has increased since 2010,especially among young White individuals residing in nonurban regions. The number of deaths from HCV had overtaken HIV/AIDS as a cause of death in the United States by 2007 and increased to 17,253 in 2015. In developed countries, the most common route of HCV transmission is injection drug use, and the steady increase in the number of reported cases of acute HCV is heavily influenced by the opioid crisis and increased surveillance. In resource-limited countries, invasive procedures or injection-based therapies with contaminated instruments are the predominant source of new infections. Although the proportion of patients on the liver transplant waiting list or undergoing liver transplantation for chronic HCV infection has been decreasing, largely due to the availability of more effective drugs for HCV, the overlapping epidemics of HCV and metabolic syndrome remains a concern. 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.

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    2. 3-2

      Management of Hepatitis C Infection

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

      • Last Reviewed: 1/9/2021

      • 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 in some circumstances 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 )