Newly Released July 2017
The goal of this curriculum is to provide an evidence-based online curriculum for healthcare providers and trainers of healthcare providers to increase their knowledge on human immunodeficiency virus (HIV) and hepatitis C virus (HCV) co-infection among people of color in the United States and its territories Topics covered include prevention, screening, diagnosis and treatment recommendations as well as barriers and other co-factors that may impede optimal treatment outcomes for co-infected people of color.
A team of AETC Program faculty and staff identified six core competencies for providers treating co-infected people living with HIV (PLWH). Within each topic area, there are multiple lessons. Click on curriculum logo image to view more information!
CME/CE-certified Interactive Virtual Presentation: Hepatitis C Update for Primary Care
Terry D. Box, MD
Tailored for primary care clinicians, test your knowledge of best practices for HCV screening, evaluation, and linkage to care in this interactive presentation and then find out how to consider treating HCV in your practice.
Downloadable slides from the presentation are available for review or use in your own presentations.
Hepatitis C Overview
- Hepatitis C infection can remain silent for decades without symptoms
- Hepatitis C virus (HCV) is the most common chronic blood borne infection in the US
- Chronic Hepatitis C is one of the most important health issues facing the nation
- 2 million Persons are estimated to be chronically infected in the U.S.
- 50% of those infected with HCV are unaware of being infected
- In 2007 the death rate of Hepatitis C has surpassed that of HIV
- HCV therapy can lead to a cure
Who is at risk of Hepatitis C?
HCV testing is recommended for anyone at increased risk for HCV infection, including:
- Persons born from 1945 through 1965 “baby –boomers”
- Persons who have ever injected illegal drugs
- Recipients of clotting factor concentrates made before 1987
- Recipients of blood transfusions or solid organ transplants before July 1992
- Patients who have ever received long-term hemodialysis treatment
- Persons with known exposures to HCV, such as
- health care workers after needle sticks involving HCV-positive blood
- Recipients of blood or organs from a donor who later tested HCV-positive
- All persons with HIV infection
- Patients with signs or symptoms of liver disease (e.g., abnormal liver enzyme tests)
- Children born to HCV-positive mothers (to avoid detecting maternal antibody, these children should not be tested before age 18 months)
Sixty to 70% of persons newly infected with HCV are usually asymptomatic or have a mild clinical illness. HCV RNA can be detected in blood within 1–3 weeks after exposure. The average time from exposure to antibody to HCV (anti-HCV) seroconversion is 8–9 weeks, and anti-HCV can be detected in >97% of persons by 6 months after exposure. Chronic HCV infection develops in 70%–85% of HCV-infected persons; 60%–70% of chronically infected persons have evidence of active liver disease. The majority of infected persons might not be aware of their infection because they are not clinically ill. However, infected persons serve as a source of transmission to others and are at risk for chronic liver disease or other HCV-related chronic diseases decades after infection.
HCV is most efficiently transmitted through repeated percutaneous exposure to infected blood, as a result injection drug use has been the principal mode of transmission of HCV since the 1970’s. Transfusion associated HCV infection is very rare (1 in 2 million) in the US since advanced detection techniques started being used in 1992 (CDC). Although much less frequent, occupational, perinatal, and sexual exposures also can result in transmission of HCV.
Sexual Transmission of HCV
Sexual transmission of HCV is a controversial issue. It is possible that HCV is transmitted sexually, but that mode of transmission in generally considered inefficient. Case-control studies have reported an association between acquiring HCV infection and exposure to a sex contact with HCV infection or exposure to multiple sex partners. Surveillance data also indicate that 15%–20% of persons reported with acute HCV infection have a history of sexual exposure in the absence of other risk factors. Case reports of acute HCV infection among HIV-positive MSM who deny injecting-drug use have indicated that this occurrence is frequently associated with other STDs (e.g., syphilis). In contrast, a low prevalence (1.5% on average) of HCV infection has been demonstrated in studies of long-term spouses of patients with chronic HCV infection who had no other risk factors for infection. Multiple published studies have demonstrated that the prevalence of HCV infection among MSM who have not reported a history of injecting-drug use is no higher than that of heterosexuals. Because sexual transmission of other bloodborne viruses, such as HIV, is more efficient among homosexual men than in heterosexual men and women, the reason that HCV infection rates are not substantially higher among MSM is unclear.(source: MMWR. 1998 Oct 16. CDC)
Nevertheless, people living with HIV (PLWH) are at risk of HCV infection, studies have shown that sexual transmission is a significant risk for HIV infected men who have unprotected sex with men.
(source: CDC Viral Hepatitis –Statistics and Surveillance in the US 2013)
Prevalence of Hepatitis C in the US:
Prevalence in terms of Hepatitis C refers to people living with active chronic hepatitis C. One of the most recent NHANES surveys from 2003 to 2010, estimated a 1.0% prevalence of hepatitis C in the US which amounts to 2.7 million people. (source: Hepatology. 2015 Jul 14. Edlin BR, et al)
Diagnosis and Treatment for Hepatitis C
The diagnosis and clinical management of Hepatitis C is a fast changing science. There are many sources of current information for clinicians and other health care providers.
HIV and Hepatitis C co-infection
- AIDs Info: Considerations for Antiretroviral Use in Patients with Coinfections
- HIV and Viral Hepatitis Fact Sheet (PDF)
- Viral Hepatitis Populations
- HCV/HIV Co-infection: An AETC National Curriculum – AETC NCRC, MidAtlantic AETC, New England AETC, Northeast/Caribbean AETC, South Central AETC, Southeast AETC
- AETC National HIV Curriculum, Co-Occurring Conditions – University of Washington, AETC NCRC
- Hepatitis C Online – University of Washington, CDC
- Hepatitis C Management – AETC NCCC – online or phone clinician-to-clinician consultation
Slides, Toolkits, Webinars
- HCV Update for Pharmacists – Northeast/Caribbean AETC
- From Diagnosis to Treatment: How to Build an HCV Clinical Toolkit – Southeast AETC
- HIV/HCV Coinfection: Why It Matters and What To Do About It – Southeast AETC
- From Prescription to Patient: Navigating Barriers to HCV Treatment Initiation – Southeast AETC
- HCV Treatment in 2016: Genotypes 1, 2, and 3 – Southeast AETC
- HCV Pretreatment Evaluation – Southeast AETC
- HIV and HCV Drug Interactions: A Quick Guide for Clinicians– Northeast/Caribbean AETC
Click here to review “Combating the Silent Epidemic of Viral Hepatitis: Action Plan, for prevention, Care & Treatment of Viral Hepatitis, US DHHS” – Updated 2014-2016
- TARGET Center
- American Association for the Study of Liver Diseases
- Infectious Disease Society of America
- Action Plan for the Prevention, Care & Treatment of Viral Hepatitis (updated 2014-2016)
- CDCs National Prevention Information Network (NPIN)
- International Antiviral Society-USA’s Upcoming Webinars
- other Hepatitis guidelines and web resources can be found under our Resources tab above: