Hepatitis C - An update on the silent epidemic

Hepatitis C virus (HCV) currently infects an estimated 2-3 million people i n the United States and 175 million people globally. Over 80% of infected p atients go on to develop chronic disease. Most patients remain asymptomatic despite silent, insidious progression of the disease. The sequelae of HCV- induced chronic liver disease accounts for 8,000-10,000 deaths annually in the United States and is currently the leading indication for liver transpl antation. The cost of this epidemic to the United States was estimated in 1 991 at $600 million in terms of medical expenses (excluding costs related t o liver transplantation) and work lost. Over the last decade, since the vir al genome of HCV was first sequenced in 1989, there has been a great increa se in understanding of this infection. This review summarizes current knowl edge about the hepatitis C epidemic with particular reference to epidemiolo gy of infection, viral characteristics, risk factors for disease, diagnosti c testing, clinical manifestations, and current, as well as potential, ther apeutic options.