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Hepatitis C screening

Hepatitis C screening. Curtis Barry, MD ECHO. The Hepatitis C Epidemic. Prevalence of hepatitis C Worldwide: 170 million (3%) US: 4 million (1.8%) HCV Ab positive 80% are estimated to be viremic Most patients are asymptomatic until irreversible damage occurs.

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Hepatitis C screening

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  1. Hepatitis C screening Curtis Barry, MD ECHO

  2. The Hepatitis C Epidemic • Prevalence of hepatitis C • Worldwide: 170 million (3%) • US: 4 million (1.8%) HCV Ab positive • 80% are estimated to be viremic • Most patients are asymptomatic until irreversible damage occurs CDC. MMWR 1998:47 (No. RR-19);1-39

  3. The Hepatitis C Epidemic (cont.) CDC. MMWR. 1998; 47(No. RR-19):1-39. NIH Consensus Development Conference Panel Statement Management of Hepatitis C, 2002 • A leading cause of cirrhosis in the US • 10,000-20,000 deaths/year • This number expected to triple in the next 10 years (without therapy) • Associated with an increased risk of liver cancer • Accounts for an estimated 1/3 of HCC cases in the US • Leading indication for liver transplantation in US

  4. Clinical Presentation of Chronic Hepatitis C • Often asymptomatic • Picked up by uncovering risk factors • Mild abnormalities of LFTs • If symptomatic suggests advanced fibrosis • Jaundice, ascites, hepatic encephalopathy

  5. Hepatitis C: A Global Health Problem 170 Million Carriers Worldwide, 3-4 M new cases/year EAST MEDITERRANEAN 20M WEST EUROPE 9 M FAR EAST ASIA 60 M U.S.A. 4 M SOUTH EAST ASIA 30 M AFRICA 32 M SOUTH AMERICA 10 M AUSTRALIA 0.2 M SOURCE, WHO 1999

  6. Risk Factors for Hepatitis C Occupational Accidental needle sticks Mucosal exposures Medical Blood transfusion (before 1992). Clotting factors before 1987 Organ transplantation (before 1992) Lifestyle • IVDA • Intranasal cocaine • Tattooing/piercings with contaminated needles/ink • High-risk sexual activity • Multiple partners • History of STDs

  7. Screening for Chronic Viral Hepatitis C Unexplained elevations of transaminases Patients with HIV Patients on hemodialysis Children born to HCV + mothers Sexual exposure, multiple partners Baby Boomers (1946-1964) History of incarceration CDC and Prevention.MMWR Recomm Rep. 1998;47(RR-19):1-39.

  8. Hepatitis C: A Global Health Problem 170 Million Carriers Worldwide, 3-4 M new cases/year EAST MEDITERRANEAN 20M WEST EUROPE 9 M FAR EAST ASIA 60 M U.S.A. 4 M SOUTH EAST ASIA 30 M AFRICA 32 M SOUTH AMERICA 10 M AUSTRALIA 0.2 M SOURCE, WHO 1999

  9. Hepatitis C Antibody (Anti-HCV) Test • Used for screening and diagnosis • Sensitivity over 99% (immunocompetent) • Detected 8-12 weeks after exposure Management of Hepatitis C. NIH Consensus Statement, 2002.

  10. Detection of Viral Hepatitis: HCV RNA Testing • RT-PCR (reverse transcription-polymerase chain reaction) • Quantitative (reported in IU/mL rather than copies/mL) • Specificity is 98-99% • Detected as early as 2 wks after exposure • Used if HCV antibody detected (or as clinically indicated) Pawlotski JM, Hepatology,November 2002

  11. Outcome Following HCV Infection 20-50 yrs 100 85% Chronic85 15% 20% Cirrhosis17 Resolve15 80% 25% 75% Mortality4 Stable68 Stable13 Courtesy of Seeff, LB and Alter, HJ.

  12. CDC Recommended Testing Sequence for Identifying Current HCV infection

  13. QUESTIONS?

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