Hepatitis C virus: A time for decisions. Who should be treated and when?

Table 1 Individuals at high risk for hepatitis C virus infection

Individuals working in emergency departments
Anesthesiologists
First responders
Fire
Police
Ambulance attendants
Individuals undergoing chronic hemodialysis
Healthcare workers including employees in dialysis center
Institutional residents (prisons, individuals with physical, mental, and developmental abnormalities)
Individuals born between 1945-1965
Those receiving blood or blood products before 1992
Intravenous drug abusers
Presence of human immunodeficiency virus infection or individuals with high risk sexual behaviors

Table 2 Goals of treatment of hepatitis C virus

Current goals of HCV treatment
Cure HCV infection in those infected with the virus
Reduce the downstream consequences of chronic hepatitis C
Prevent cirrhosis
Prevent decompensation of cirrhosis
Prevent hepatocellular carcinoma
Reduce the requirement for liver transplantation in individuals with chronic hepatitis C
Improve life quality of those with HCV
Reduction of all-cause as well as liver disease mortality
Ideal goals of HCV treatment:
Eliminate HCV disease in its all of varied manifestations (both hepatic and extrahepatic)
Reduce the number of individuals infected with minimal or no liver disease who are important transmitters of the virus within the population
Improve the life expectancy and quality of those infected with HCV regardless of the specific clinical presentation of their infection

HCV: Hepatitis C virus.

Table 3 Factors potentially contributing to fibrosis progression in individuals with chronic hepatitis C virus

Established factors1	More recently identified risk factors
Duration of HCV infection	Patient age at time of diagnosis
Older age at infection	Genotype 3 infection
Male gender	Insulin resistance
Presence of baseline fibrosis	Gene polymorphisms involved in inflammation and iron metabolism
HIV coinfection1/CD4 count < 200 cells/mL	Human leukocyte antigen DRB1*1201-3 allele
Long term alcohol consumption	Latin ethnicity
(> 20-50 g/d)	Daily cannabis use
HBV coinfection
Metabolic syndrome (steatosis, insulin resistance, type 2 diabetes)

¹HCV viral load and mode of infection are not associated with faster fibrosis progression. HCV: Hepatitis C virus; HIV: Human immunodeficiency virus; HBV: Hepatitis B virus.

Table 4 Extrahepatic manifestations associated with hepatitis C virus infection

Neuropsychiatric	Ocular
Depression	Corneal ulcer
Cerebral vasculitis	Uveitis
Endocrine	Autoimmune phenomena
hypothyroidism	CREST syndrome
Diabetes mellitus	Thyroiditis/hypothyroidism
Thyroiditis	Sicca syndrome
Neuromuscular	Renal
Weakness/myalgia	Membranous glomerulonephritis
Peripheral neuropathy	Nephrotic syndrome
Arthritis/arthralgia	Cryoglobulinemia related glomerulonephritis
Vascular	Hematologic
Necrotizing vasculitis	Aplastic anemia
Polyarteritis nodosa	Thrombocytopenia
Cryoglobulinemia	Non-Hodgkin’s B cell lymphoma
Dermatologic
Porphyria cutanea tarda
Lichen planus
Cutaneous necrotizing vasculitis
Livedo reticularis