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HCV Article-Marty

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  • 2byteme@bellsouth.net
    overlooked epidemic, Part II 3/19/2001 Find out why no vaccine has yet addressed this “silent epidemic”--one that’s far more likely to be transmitted by
    Message 1 of 1 , Mar 24, 2001
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      overlooked epidemic, Part II
      3/19/2001 Find out why no vaccine has yet
      addressed this “silent
      epidemic”--one that’s far more likely to be
      transmitted by
      occupational needlestick injury than HIV. For Part
      I, click here.

      By Lisa Black, RN, BSN

      Often called the “silent epidemic,” Hepatitis C
      is transmitted primarily by blood-to-blood
      contact with an infected source. The World
      Health Organization estimates that more than
      170 million people worldwide are infected,
      including 4 million people in the United
      States, although many of the infected remain

      While the majority of new Hepatitis C virus
      (HCV) transmissions are a result of illicit drug
      use, occupationally
      infected healthcare workers represent an
      ever-growing subset of the
      HCV infected population. Given that an
      occupationally exposed
      healthcare worker runs a 2% to 10% risk of
      seroconversion after a
      single HCV exposure, HCV is greater than 100 times
      more likely to
      be transmitted by an occupational needlestick
      injury than HIV.

      Hepatitis C has earned its alias as the silent
      epidemic because, in a
      great number of people, the disease remains
      “silent” for years or
      decades, and only becomes evident when the virus
      has caused
      irreparable liver damage. In fact, only 10% of
      patients infected with
      HCV report an acute hepatic illness when they
      acquire the infection.
      Notwithstanding the initially asymptomatic nature
      of the majority of
      infections, over 85% of those infected will become
      chronic carriers of
      the virus and many of those will eventually
      develop liver disease, often
      necessitating liver transplantation or leading to
      premature death.

      Elusive bug
      The Hepatitis C virus has, thus far, proved
      elusive to researchers, and
      unlike hepatitis A and B, there is no vaccine to
      prevent hepatitis C
      infection. The explanation for this failure lies
      within the structure of the
      Hepatitis C virus.

      The hepatitis C virus is an RNA virus that
      replicates via a virally
      encoded RNA polymerase. The replication cycle of
      the virus
      generates large numbers of “mutant viruses”
      differing from the parent
      strain by possibly only a few nucleotides. Each
      minute mutation,
      however, changes the virus’s structure, which
      renders any previously
      developed vaccine ineffective. The mutation rate
      with hepatitis C is
      such that various “quasi-species” may exist
      simultaneously within
      any given carrier, further complicating efforts to
      treat the disease.

      Related groups
      Although every hepatitis C virus is unique and
      changes rapidly,
      careful comparison of viral sequences has allowed
      HCV to be grouped
      into closely related groups known as genotypes.
      Within each
      genotype, the virus is similar to the group’s
      other members but differs
      greatly from those in other genotype groups.

      The various HCV genotypes tend to be endemic to
      geographic locations. In the United States,
      genotypes 1, 2 and 3
      predominate, with genotype 1 being the most
      common, and,
      unfortunately, the most difficult to treat.

      While differing HCV genotypes don’t appear to have
      a direct effect on
      the natural history of the disease, there is a
      significant difference in
      response to treatment among genotype groups.
      Emerging treatment
      studies are boasting an 88% rate of “cure” in
      patients infected with
      genotypes 2 and 3 (as expressed by a sustained
      virus clearance six
      months after treatment). But the same treatment
      yields only a 48%
      efficacy in those carrying genotype 1 HCV

      In the next article in this series, I’ll review
      the history and evolution of
      HCV treatment, and discuss some of the promising
      options on the horizon.

      Send questions or comments to Lisa at
      lisa.rn@.... Please
      also visit her website dedicated to needlestick
      injury prevention
      at www.needlestick.net.

      Click here for more Sharps Safety.

      The Gastroenterology Treatment Reporter,
      ”Achieving Optimum
      Outcomes: Customizing Treatment for Patients with
      HCV Infection,”
      January 23, 2001.
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