February 2002 · Vol. 14, No. 2Hepatitis C: the silent epidemic
Though frequently asymptomatic in its initial stages, hepatitis C infection can have serious consequences, including cirrhosis, liver failure, cancer, and death. Early detection of the virus is beneficial, as it enables women to take advantage of increasingly effective treatments and alerts them to the need for preconception counseling.
KATHERINE
T.
CHEN,
MD, MPHDr. Chen is an instructor at Harvard Medical School and associate Ob/Gyn at Brigham and Women’s Hospital in Boston, Mass.
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Key points
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The hepatitis C virus (HCV) is the leading cause of chronic liver disease and the leading indication for liver transplantation in the United States.
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In the United States, 3.9 million people have been infected with HCV, with an overall prevalence of 1.8%. In females, prevalence is highest during the childbearing years, peaking at age 35.
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Injection-drug use accounts for 60% of infections, while the transfusion of blood or blood products accounts for another 10%.
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About 15% of people with acute HCV infection clear the virus; the rest develop chronic infection.
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During chronic infection, most patients are asymptomatic or have mild, nonspecific symptoms such as fatigue.
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Combination therapy with interferon alpha and ribavirin elicits a sustained virologic response rate of 40%, and newer therapy with pegylated interferon alpha and ribavirin improves the rate to 54%.
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Perinatal transmission in women with chronic HCV infection occurs at an average rate of 5%.
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The hepatitis C virus (HCV) was first identified in 1989 as the cause of non-A, non-B hepatitis infections. Since its discovery, HCV has become the most common chronic blood-borne infection in the United States: Approximately 2.7 to 3.5 million people have chronic HCV infection,1,2 as compared with 1.25 million people with chronic hepatitis B virus infection and 1 million with the human immunodeficiency virus (HIV). In addition, HCV infection is the leading cause of chronic liver disease and the leading indication for liver transplantation in the United States. Some call HCV infection “the silent epidemic,” since 75% of people infected are asymptomatic and chronic manifestations don’t appear for 1 to 2 decades.
In 1998, the Centers for Disease Control and Prevention (CDC) issued guidelines for screening for HCV infection (Table 1).3 The American College of Obstetricians and Gynecologists (ACOG) advocates screening for HCV infection at the annual exam if the patient belongs to one of the CDC’s routine-screening categories.4 Although ACOG has not issued separate screening guidelines for obstetric patients, some practitioners have advocated screening based on risk factors, as listed in the CDC’s routine-screening categories.5
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