Understanding hepatitis C.
Chronic hepatitis C virus (HCV) infection affects over 170 million people worldwide and is a common cause for liver transplantation in Canada. The prevalence of HCV infection in the dialysis population is estimated to be 20% to 50%. Today, intravenous drug use remains the most common route of transmission. The risk of acquiring HCV infection in patients on long-term hemodialysis is expected to decrease because of the screening of blood products for HCV. The diagnostic tests for hepatitis C include anti-HCV, HCV RNA, serum ALT levels, and liver biopsy. Liver biopsy is the definitive diagnostic procedure. Of patients acutely infected with the virus 50% to 85% will become carriers. HCV infection progresses slowly and the minority of patients develop cirrhosis over 20 years. The risk of hepatocellular carcinoma is increased once cirrhosis is present. The current standard of treatment that employs interferon and ribavirin has its limitations and is not indicated for many patients groups, such as patients on long-term hemodialysis. Interferon monotherapy is possible but is poorly tolerated by patients on dialysis. Patient and family education, as well as counselling, are important in that patients infected with HCV should be partners with health care providers in the management of their disease.
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Division of Gastroenterology, Toronto Western Hospital, University Health Network, Toronto, Ontario.
D000328:Adult; D006526:Hepatitis C; D019698:Hepatitis C, Chronic; D006801:Humans; D008297:Male