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[Hepatitis C virus infection. Overview. SEVHEP (Swiss Experts on Viral Hepatitis)]
P J Grob1, F Negro, E L Renner
1Abteilung Klinische Immunologie, Universitätsspital Zürich.
Insights
Hepatitis C virus (HCV) infection often becomes chronic, with diagnosis relying on anti-HCV tests and genotyping. Treatment combines interferon-alpha and Ribavirin, though outcomes vary based on risk factors like drug use.
Area of Science:
- Hepatology and Virology
- Immunology
- Epidemiology
Context:
- Hepatitis C virus (HCV) exhibits significant genetic diversity with six genotypes and numerous subtypes.
- HCV is typically non-cytopathogenic, with pathogenesis likely linked to host immune responses.
- Chronic infection develops in over 70% of cases, complicating understanding of disease progression.
Purpose:
- To review the epidemiology, diagnostics, and treatment of Hepatitis C virus infection.
- To highlight the challenges in understanding conflicting data on chronic hepatitis, cirrhosis, and hepatocellular carcinoma.
- To outline the diagnostic approach, including anti-HCV screening, genotyping, and HCV-RNA measurement.
Summary:
- HCV is primarily transmitted via contaminated needles, particularly among intravenous drug users.
- Risk factors such as age, gender, coinfections (HBV, HIV), and alcohol consumption influence disease outcomes.
- The standard therapy involves a combination of interferon-alpha and Ribavirin, showing improved efficacy.
Impact:
- HCV prevalence in Switzerland is estimated at 0.75-1%, affecting 50,000-70,000 people.
- An increase in HCV-associated liver cirrhosis, liver transplantation, and mortality is anticipated.
- Collaborative efforts, including a Swiss HCV cohort study, are underway to address the disease burden.
Abstract:
The hepatitis C virus (HCV) shows a pronounced polymorphism with six genotypes and many subtypes. The virus is generally not cytopathogenic. Immunological defence mechanisms are probably essential for the pathogenecity. An acute hepatitis is relatively rare; the infection becomes chronic in over 70%. The data on the occurrence of chronic hepatitis, cirrhosis and hepatocellular carcinoma are conflicting. The age at infection, the gender, coinfections with HBV and HIV and alcohol consumption play a role. The basis of diagnostics is the anti-HCV screening test with clear indications for the measurement of the genotype and of HCV-RNA. The combination of interferon-alpha and Ribavirin is the therapy of choice with improved success. HCV is most often transmitted through contaminated syringes and needles, i.v. drug users having the greatest incidence and prevalence. Vertical and sexual HCV transmission is relatively rare. It is estimated that the HCV prevalence in Switzerland is 0.75-1%, afflicting 50,000-70,000 individuals. Over the next years the number of HCV associated decompensated liver cirrhosis, liver transplantation and death will grow. Efforts of collaboration in the field are undertaken including the establishment of a Swiss HCV cohort study.