How is Hepatitis C (Hepatitis C virus) transmission prevented and treated?

Hepatitis C Transmission Prevention and Treatment

Hepatitis C virus (HCV) transmission can be effectively prevented through specific precautions, and current treatments can cure the infection in >90% of cases with direct-acting antiviral medications. 1

Prevention of HCV Transmission

Risk Behaviors and Exposures

HCV is primarily transmitted through blood-to-blood contact. Major risk factors include:

• Injection drug use (current or past, even single use)
• Intranasal illicit drug use
• Men who have sex with men
• Long-term hemodialysis
• Percutaneous/parenteral exposures in unregulated settings
• Healthcare worker exposures (needle sticks, sharps, mucosal)
• Mother-to-child transmission
• Prior incarceration
• Blood transfusions or organ transplants prior to 1992
• Clotting factor concentrates prior to 1987 1

Preventive Measures for HCV-Infected Persons

HCV-infected individuals should:

• Avoid sharing personal items that may have blood contact:
  • Toothbrushes
  • Dental or shaving equipment
  • Nail clippers 1
• Cover any bleeding wounds to prevent others' contact with blood
• Stop using illicit drugs and enter substance abuse treatment
• For those continuing to inject drugs:
  • Use new sterile syringes and filters
  • Avoid reusing or sharing syringes, needles, water, cotton, or other equipment
  • Clean injection sites with new alcohol swabs
  • Dispose of needles safely in puncture-proof containers 1
• Not donate blood, organs, tissues, or semen
• Discuss HCV status before donation 1
• Clean blood-contaminated surfaces with 1:9 bleach solution while wearing gloves 1

Sexual Transmission Prevention

• Sexual transmission risk is generally low
• Barrier protection (condoms) recommended for:
  • Persons with HIV/HCV coinfection
  • Those with multiple sexual partners
  • Those with sexually transmitted infections
  • Promiscuous individuals and homosexual men 1
• For monogamous couples, barrier protection is not necessary 1

Vertical Transmission Prevention

• Risk of mother-to-child transmission is low (1-6%)
• Caesarean sections are not recommended specifically to prevent HCV transmission
• Breastfeeding is allowed for HCV-infected mothers who are HIV-negative and not using intravenous drugs 1
• Children of HCV-infected mothers should be tested for HCV RNA one month after birth 1

Healthcare Settings

• Universal precautions should be followed
• Medical health professionals should be tested for anti-HCV
• HCV RNA-positive health professionals should avoid activities with increased risk of accidental puncture or skin/mucosa breaks 1
• Proper disinfection, cleaning, and management of materials and instruments are essential in all medical and invasive procedures 1

Treatment of HCV Infection

Goals and Endpoints

• The primary goal of therapy is to eradicate HCV infection to prevent complications including liver disease, cirrhosis, hepatocellular carcinoma, and death 1
• The endpoint of therapy is sustained virological response (SVR), which equates to cure of infection in >99% of patients 1

Current Treatment Options

Direct-acting antiviral agents (DAAs) are the standard of care for HCV treatment:

1. For adults and children ≥3 years with genotype 1,4,5, or 6:

   • Ledipasvir/sofosbuvir (90mg/400mg) daily for 12 weeks 2

2. For children ≥12 years with genotype 2 or 3:

   • Sofosbuvir with weight-based ribavirin for 12 weeks (genotype 2) or 24 weeks (genotype 3) 3

3. Treatment success rates:

   • 90% cure rates across most patient populations 2, 3

Special Considerations

• Monitor for HBV reactivation in coinfected patients during or after HCV treatment 2, 3
• Patients should be vaccinated against hepatitis A and B 1
• Avoid alcohol intake during treatment 4
• Drug interactions should be carefully monitored; patients should report all medications to their healthcare provider 2, 3

Testing Recommendations

• Test persons with risk factors for HCV infection 1
• Testing algorithm:
  1. Initial anti-HCV antibody test
  2. If positive, confirm with HCV RNA test to document viremia
  3. Assess liver disease severity with non-invasive tests (ALT, AST, albumin, bilirubin, INR, CBC with platelet count, transient elastography) 1

Common Pitfalls and Caveats

• HCV antibody tests may be negative during the first 6 weeks after exposure
• Seroconversion may be delayed or absent in immunosuppressed individuals
• HCV RNA may fluctuate during acute infection
• ALT may be normal during acute infection or elevated due to other causes 1
• The effect of treatment on HCV transmission is not fully established; appropriate precautions should still be taken 2, 3
• Family members of HCV-infected patients should be tested at least once for anti-HCV 1

By implementing these prevention strategies and utilizing current treatment options, the burden of HCV infection can be significantly reduced, improving outcomes for affected individuals and limiting further transmission.