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IV Drug Use and Hep C

Hepatitis C or Hep C is an infectious disease affecting the liver, caused by the Hepatitis C virus (HCV). The infection is often asymptomatic, but chronic infection can lead to scarring and cirrhosis of the liver, which doesn’t become apparent until many years later. In some cases, those with cirrhosis will go on to develop liver cancer, liver failure or life-threatening esophageal and gastric varices.

Hep C is spread primarily by blood-to-blood contact associated with intravenous drug use, poorly sterilized medical equipment and transfusions. Worldwide, an estimated 130 to 170 million people are infected with Hep C.

The virus persists in the liver in about 85% of those infected. This persistent infection can be treated with medication. Typically the therapy is a combination of Peginterferon and Ribavirin, sometimes also with either Boceprevir or Telaprevi. 50% to 80% of the people who are treated are cured. Those who develop cirrhosis or liver cancer may require a liver transplant. Hepatitis C is the leading cause of liver transplants, though the virus usually recurs after transplantation. There is no vaccine available against Hepatitis C.

Hep C infection causes acute symptoms in 15% of infected cases. Symptoms are generally mild, including decreased appetite, fatigue, nausea, muscle or joint pain, and weight loss. Most cases of acute infection are not associated with jaundice. The infection goes away by itself in 10% to 50% of cases, which occurs more frequently in individuals who are young and female.

About 80% of the people who are exposed to the virus develop a chronic infection. Most experience minimal or no symptoms at all during the initial few decades of the infection, although chronic Hep C can be associated with fatigue. About 10% to 30% of people develop cirrhosis within 30 years. Cirrhosis is more common among men, and in those who are also infected with hepatitis B or HIV, and in alcoholics.

Those who develop liver cirrhosis have a 20 times greater risk of hepatocellular carcinoma, and if this is complicated by excess alcohol the risk becomes 100 times greater. Hepatitis C is the cause of 27% of cirrhosis cases and 25% of hepatocellular carcinoma worldwide.

The primary route of transmission in the developed world is intravenous drug use, while in the developing world the main methods are blood transfusions and unsafe medical procedures. It is very rare (but not impossible) to transmit hepatitis C through sex.

IV drug use is a major risk factor for Hep C in many parts of the world. In a study of 77 countries, 25 of those countries, including the United States, were found to have a high rate (between 60% to 80%) of Hep C in the intravenous drug user population. In twelve countries the rates were even higher than 80%. Worldwide, an estimated ten million IV drug users are infected with hepatitis C. The 3 countries with the most Hep C infected drug users are: 1.6 million in China, 1.5 million in the United States, and 1.3 million in Russia.

Occurrence of hepatitis C among prison inmates in the United States is 10 to 20 times that of the occurrence observed in the general population; probably due to high-risk behavior in prisons such as IV drug use and tattooing with nonsterile equipment.

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