Hepatitis C and Co-morbidities in the United States
Susan A.
November 30, 2014

Abstract
Hepatitis simply defined indicates inflammation of the liver. Hepatitis C is a disease caused by a specific virus (HCV) which spreads primarily through contact with the blood of an infected person. Hepatitis C can be either acute or chronic. In the early stages, many are asymptomatic and if symptomatic, complaints are typically vague. The CDC estimates the prevalence of HCV to be 2.7-3.9 million in the U.S as of 2012. Treatment of HCV utilizes two types of drugs in combination. The only effective treatment for late stage liver disease is transplantation of the liver. The total lifetime cost for this disease is estimated, based upon a population of 3.6 million, to be $360 billion. Currently, injection drug use is the leading risk factor for HCV transmission in the United States and can be acquired from the use of shared, unsterilized needles. Recent studies reveal coexistent HCV infection has been estimated to be present in 10% to 15% of patients with chronic hepatitis B, and is more common among injecting drug users. Co-infection with HIV nearly doubled the risk of death from HBV-related complications and quadrupled the risk of death from HCV-associated liver disease. Prevention programs have been aimed at avoiding needle sharing among IV drug users. Needle exchange programs and educational interventions have reduced transmission of HCV infection. Public health investments at community, state, and national levels are essential to build strong prevention programs that interrupt transmission of viral hepatitis and improve the health of those who are already infected.

Objectives
1. To define Hepatitis C Virus and how co-morbidities impact disease progression
2. Recognize the incidence and prevalence of hepatitis C in the United States
3. Identify individuals at risk for infection by HCV
4. Indicate how the hepatitis C virus (HCV) is transmitted
5. Describe the physiology and pathophysiology of HCV
6. Explore treatment options and how co-morbidities effect the disease
7. Discuss the burden of disease and prevention measures for HCV and how it impacts public health in the U.S.

Hepatitis simply defined indicates inflammation of the liver. Hepatitis C is a disease caused by a single-stranded RNA virus in the Flaviviridae family spread primarily through contact with the blood of an infected person. The HCV genome contains approximately10, 000 nucleotides (MedicineNet.com, 2012). Hepatitis C can be either acute or chronic, the former occurring within the first 6 months after exposure. Typically, acute infection leads to the chronic disease. HCV infection leads to serious problems, including cirrhosis or liver cancer (CDC, 2013).
HCV was discovered in 1989. Before that time, hepatitis C was referred to as non-A, non-B hepatitis because the virus could not be identified (MedicineNet.com, 2012).
The liver, located on the right side of the abdomen, weighs roughly 2.6-3.5 pounds and performs many necessary functions. Among the most important liver functions are removal and excretion of body wastes, hormones, many drugs and other foreign substances. The liver also is responsible for synthesizing plasma proteins, producing immune factors, removing bacteria, and helping the body fight infection. The phagocytes in the liver produce acute-phase proteins in response to microbes which are associated with the inflammation process, tissue repair, and immune cell activities. There are also many other important but less immediate functions of the liver (Brown University, 2002). HCV causes inflammation to the liver, impairing its blood supply and ability to perform its primary and secondary functions. (RN Speak, 2012).
HCV infection is often silent until asymptomatic persons are identified as HCV-positive during routine screenings or exams. Those with newly acquired HCV infection usually are asymptomatic or have mild