Hepatitis C

Hepatitis C is likely to become a significant public health problem in the UK in the next decade. It is thought around 200,000 people are chronically infected with the virus. At risk groups include intravenous drug users and patients who received a blood transfusion prior to 1991 (e.g. haemophiliacs).

Pathophysiology

• hepatitis C is a RNA flavivirus
• incubation period: 6-9 weeks

Transmission

• the risk of transmission during a needle stick injury is about 2%
• the vertical transmission rate from mother to child is about 6%. The risk is higher if there is coexistent HIV
• breast feeding is not contraindicated in mothers with hepatitis C
• the risk of transmitting the virus during sexual intercourse is probably less than 5%

Features

• After exposure to the hepatitis C virus only around 30% of patients will develop features such as:
  • a transient rise in serum aminotransferases / jaundice
  • fatigue
  • arthralgia
• less than 20% of patients develop an acute hepatitis
• there is no vaccine for hepatitis C

around 15-45% of patients will clear the virus after an acute infection (depending on their age and underlying health) and hence the majority (55-85%) will develop chronic hepatitis C

Complications

• chronic infection (80-85%) - only 15-20% of patients will clear the virus after an acute infection and hence the majority will develop chronic hepatitis C
• cirrhosis (20-30% of those with chronic disease)