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Abstract:

This chapter focuses on disease burden and the natural history of chronic liver disease due to hepatitis C virus (HCV) infection and highlights recent advances in therapy. Hepatitis C is the indication for an increasing proportion of liver transplants in the United States, accounting for 36% of all transplants in 1999. A study of anti-HCV-positive adolescents and young adults (mean age of 19.8 years) who had received blood transfusions as infants or young children showed that less than 60% had persistent infection. Of 17 patients who underwent liver biopsies, only two had portal fibrosis; both patients also had congestive heart failure. One recent review of published studies that evaluated progression to cirrhosis in cohorts of hepatitis C patients defined four categories based on how patients were recruited: cross-sectional studies of patients seen in referral practices; longitudinal studies of patients with posttransfusion hepatitis; case series of blood donors found at the time of screening to be anti-HCV positive; and community-based cohorts. Considerable advances in the treatment of hepatitis C have been made over the past several years. At the time of 1997 National Institutes of Health Consensus Development Conference, the recommended therapy of a 48-week course of interferon alpha three times a week resulted in a sustained virological response (SVR) of 12 to 16%. With optimal therapy of pegylated interferon and ribavirin, patients infected with genotype 1 have lower response rates (40 to 45%) than patients infected with genotype 2 or 3 (approximately 80%).

Citation: Bell B. 2004. Hepatitis C Virus and Chronic Liver Disease, p 1-11. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch1
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Figure 1

Primary etiology of patients newly diagnosed with chronic liver disease: New Haven, Conn., and Kaiser, Alameda, Calif., 1999 ( = 342). HBV, hepatitis B virus; NAFLD, nonalcoholic fatty liver disease; alcohol, excessive alcohol intake. Other etiologies include primary biliary cirrhosis, primary sclerosing cholangitis, autoimmune hepatitis, granulomatous hepatitis, hemochromatosis, sarcoidosis, drug-induced hepatitis, cryptogenic, alpha-1-antitrypsin deficiency, and hepatocellular carcinoma. Findings are preliminary.

Citation: Bell B. 2004. Hepatitis C Virus and Chronic Liver Disease, p 1-11. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch1
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Figure 2

Effect of HCV infection incidence on future prevalence of infection. Reprinted in part from reference 3, with permission from Elsevier.

Citation: Bell B. 2004. Hepatitis C Virus and Chronic Liver Disease, p 1-11. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch1
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Figure 3

Natural history of HCV infection related to age at infection from cohort studies ( ).

Citation: Bell B. 2004. Hepatitis C Virus and Chronic Liver Disease, p 1-11. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch1
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References

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Tables

Generic image for table
Table 1

Chronic liver disease and cirrhosis mortality, United States, 1998

Citation: Bell B. 2004. Hepatitis C Virus and Chronic Liver Disease, p 1-11. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch1
Generic image for table
Table 2

Burden associated with HCV infection, United States

Citation: Bell B. 2004. Hepatitis C Virus and Chronic Liver Disease, p 1-11. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch1

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