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Hepatitis C Virus (HCV) Discovered in 1989 as a small RNA blood-borne virus with a large reservoir of chronic carriers worldwide Major cause of posttransfusion hepatitis prior to 1992 Major cause of chronic liver disease, cirrhosis, and hepatocellular carcinoma worldwide Prevalence is 0.8% of the CDN population 1990-2015: estimated 4-fold increase in the number of patients diagnosed with HCV in Canada HCV: A Global Health Problem HCV Genotypes and Subtypes Acute Hepatitis C Clinical Presentation and Natural History HCV RNA can be detected in blood within 1-3 weeks after exposure Implications for Healthcare Workers Average time from exposure to seroconversion is 8-9 weeks Average time from exposure to symptoms period 6-7 weeks Liver injury (elevations in ALT) with 4-12 weeks Symptoms develop in only of 20% of patients Nonspecific 10%-20% Jaundice in only 20%-30% Epidemiology Estimated number infected 0.8% anti HCV positively, % male 250,000-300,000 Majority between 25 and 45 years of age Estimated number diagnosed (2001) 100,000-120,000 2nd most frequently reported disease 8000 new infections per year 2000 acute Hepatitis C in Ontario Hepatitis C in Ontario Hepatitis C in Ontario Chronic Hepatitis C A leading cause of cirrhosis in the Canada 1,000-2,000 deaths/yr This number expected to triple in the next 10 to 20 years (without therapy) Associated with an increased risk of liver cancer Most common reason for liver transplantation in Canada Epidemiology of Hepatitis C How many patients are there in Ontario? Remis estimate 100,000-130,000 patients Who are they (estimates)? Ex/current IDU Immigrants from endemic areas Recipients of blood/blood products Others ? Sexual, ? cocaine, ? tattoos, etc Hepatitis C in Ontario Risk Factors for HCV Intravenous drug use (even one-time use) High risk country of origin Transfusions of blood or blood products before 1992 Current recipients of multiple blood transfusions Hemophiliacs given clotting factors Se