英文條目：https://en.wikipedia.org/wiki/Hepatitis_C
中文條目：https://zh.wikipedia.org/wiki/%E4%B8%99%E5%9E%8B%E8%82%9D%E7%82%8E
Before We Start!! (Must read)
Acute infection
Hepatitis C infection causes acute symptoms in 15% of cases.[12] Symptoms are generally mild and vague, including a decreased appetite, fatigue, nausea, muscle or joint pains, and weight loss[13] and rarely does acute liver failure result.[14] Most cases of acute infection are not associated with jaundice.[15] The infection resolves spontaneously in 10–50% of cases, which occurs more frequently in individuals who are young and female.[15]
急性感染
15%的C型肝炎感染案例導致急性症狀[12]。這些症狀通常屬於輕微和模糊，其中包括[[食慾欠佳]]，疲憊，[[噁心]]，[[肌肉]]或[[關節疼痛]]，體重下降[13]，和少數會造成[[急性肝衰竭]][14]。多數急性感染的案例並不會和[[黃疸病]]有關聯[15]。10%-50%的案例顯示感染會自發痊癒，而這通常發生在年輕人和女性的案例[15]。
Chronic infection
About 80% of those exposed to the virus develop a chronic infection.[16] This is defined as the presence of detectable viral replication for at least six months. Most experience minimal or no symptoms during the initial few decades of the infection.[17] Chronic hepatitis C can be associated with fatigue[18] and mild cognitive problems.[19] Chronic infection after several years may cause cirrhosis or liver cancer.[6] The liver enzymes are normal in 7–53%.[20] Late relapses after apparent cure have been reported, but these can be difficult to distinguish from reinfection.[20]
Fatty changes to the liver occur in about half of those infected and are usually present before cirrhosis develops.[21][22] Usually (80% of the time) this change affects less than a third of the liver.[21] Worldwide hepatitis C is the cause of 27% of cirrhosis cases and 25% of hepatocellular carcinoma.[23] About 10–30% of those infected develop cirrhosis over 30 years.[6][13] Cirrhosis is more common in those also infected with hepatitis B, schistosoma, or HIV, in alcoholics and in those of male gender.[13] In those with hepatitis C, excess alcohol increases the risk of developing cirrhosis 100-fold.[24] Those who develop cirrhosis have a 20-fold greater risk of hepatocellular carcinoma. This transformation occurs at a rate of 1–3% per year.[6][13] Being infected with hepatitis B in addition to hepatitis C increases this risk further.[25]
Liver cirrhosis may lead to portal hypertension, ascites (accumulation of fluid in the abdomen), easy bruising or bleeding, varices (enlarged veins, especially in the stomach and esophagus), jaundice, and a syndrome of cognitive impairment known as hepatic encephalopathy.[26] Ascites occurs at some stage in more than half of those who have a chronic infection.[27]
慢性感染
大約80%接觸C型肝炎病毒的人會引發慢性感染[16]。這被定義為在長達最少六個月内可被檢測到的病毒複製。多數患者在剛開始十多年被感染的經歷最輕微或甚至沒有經歷過任何症狀[17]。慢性C型肝炎會造成疲憊[18]和輕微認知問題[19]。慢性感染數年後會導致[[肝硬化]]或[[肝癌]]。7-53%的患者維持正常的肝臟酵素[20]。明顯治愈後的晚期復發的案例被證實過，但是要分辨晚期復發和再感染則是困難[20]。
大約一半的患者會出現[[肝臟脂肪化]]的現象，並且常發生在肝硬化之前[21][22]。通常（80%時候），這個變化影響少於三分之一的肝臟[21]。27%肝硬化的案例是世界性C型肝炎所致，25%則為hepatocellular carcinoma [23]。大約10-30%的患者會在30年後發生肝硬化[6][13]。肝硬化在[[B型肝炎]]，[[血吸蟲]，或艾滋病，[[酗酒]]和男性較為普遍[13]。C型肝炎患者如果飲用過多酒精，會導致肝硬化的機率增加100倍[24]。肝硬化的患者會有高達20倍患上[[hepatocellular carcinoma]] 的機率。這轉變率發生於每年1-3%[6][13]。B型和C 型的雙重感染會更加提高這個風險。
肝硬化會導致[[portal hypertension]], [[腹水]]（水分累積在肚子內），[[容易淤血或流血]]，靜脈曲張（靜脈變大，尤其是胃部和食道），[[黃疸病]]，和認知缺陷症候群，稱為 [[hepatic encephalopathy]][26]。多於一半的慢性肝炎在特定階段會發生腹水的現象[27]。
Extrahepatic complications
The most common problem due to hepatitis C but not involving the liver is mixed cryoglobulinemia (usually the type II form) — aninflammation of small and medium-sized blood vessels.[28][29] Hepatitis C is also associated with the autoimmune disorder Sjögren’s syndrome, a low platelet count, lichen planus, porphyria cutanea tarda, necrolytic acral erythema, insulin resistance, diabetes mellitus,diabetic nephropathy, autoimmune thyroiditis, and B-cell lymphoproliferative disorders.[30][31] 20–30% of people infected have rheumatoid factor — a type of antibody.[32] Possible associations include Hyde’s prurigo nodularis[33] and membranoproliferative glomerulonephritis.[18] Cardiomyopathy with associated abnormal heart rhythms has also been reported.[34] A variety of central nervous system disorders has been reported.[35] Chronic infection seems to be associated with an increased risk of pancreatic cancer.[36]
肝外並發症
丙型肝炎肝臟以外最常見問題是，{{le|混合性冷球蛋白血症|Cryoglobulinemia}}（通常為第二型） –是 一種 [[血管炎|小型和中型血管的發炎反應]][28][29]。丙型肝炎也與一些自身免疫疾病相關，例如[[干燥综合症|斯耶格倫氏綜合徵]]，{{le|低血小板|Thrombocytopenia}}，[[扁平苔蘚]]，{{le|卟啉遲發性皮膚|Porphyria cutanea tarda}}，{{le|壞死性肢端紅斑|Necrolytic acral erythema}}，[[胰島素抵抗]]，[[糖尿病]]，[[糖尿病腎病]]，自身免疫性{{le|甲狀腺炎|Thyroiditis}}，和 {{le|B細胞淋巴增殖性疾病|Lymphoproliferative disorders}}[30][31]。20 – 30% 的患者會感染類風濕因子 –一種抗體[32] 。其因素包括[[海德結節性癢疹]][33] 和 [[膜增生性腎炎]] [18]。也有報導顯示[[心肌病相關異常心臟節律]][34]是關聯疾病之一。此外，多種[[中樞神經系統疾病]]已被報導包括在内[35]。慢性丙型肝炎似乎與[[胰腺癌]][36] 風險的增加相關。
Occult infection
Persons who have been infected with hepatitis C may appear to clear the virus but remain infected.[37] The virus is not detectable with conventional testing but can be found with ultra-sensitive tests.[38] The original method of detection was by demonstrating the viralgenome within liver biopsies, but newer methods include an antibody test for the virus’ core protein and the detection of the viral genome after first concentrating the viral particles by ultracentrifugation.[39] A form of infection with persistently moderately elevated serum liver enzymes but without antibodies to hepatitis C has also been reported.[40] This form is known as cryptogenic occult infection.
Several clinical pictures have been associated with this type of infection.[41] It may be found in people with anti-hepatitis-C antibodies but with normal serum levels of liver enzymes; in antibody-negative people with ongoing elevated liver enzymes of unknown cause; in healthy populations without evidence of liver disease; and in groups at risk for HCV infection including those on hemodialysis or family members of people with occult HCV. The clinical relevance of this form of infection is under investigation.[42] The consequences of occult infection appear to be less severe than with chronic infection but can vary from minimal to hepatocellular carcinoma.[39]
The rate of occult infection in those apparently cured is controversial but appears to be low.[20] 40% of those with hepatitis but with both negative hepatitis C serology and the absence of detectable viral genome in the serum have hepatitis C virus in the liver on biopsy.[43]How commonly this occurs in children is unknown.[44]
隱匿性感染
曾被感染者雖然似乎已除掉病毒，但仍持續受感染[37]。該病毒是無法以常規的測試檢測，但能以超靈敏的測試被測出[38]。檢測的原先方式是證明病毒[[基因組]]出現在肝臟活組織中，而新的方法是通過[[超速離心]]濃縮病毒顆粒再從中檢測出病毒的核心蛋白和病毒基因組 [39]。持續中度升高的血清肝酶，但無發現抗丙型肝炎抗體，也是被報導過的一種感染形式[40]。該形式被稱為不明隱匿性感染。
這類型的感染與一些臨床驗證有關[41]。它可能會在有抗丙型肝炎抗體，但正常肝酶血清的患者中; 或在陰性抗體卻不明原因持續升高肝酶的患者中; 或無肝病的健康人群中; 與在丙型肝炎病毒感染高危人群中，其中包括洗腎者或隱匿性丙肝者的家庭成員中。這形式感染的臨床意義仍在調查中[42]。隱匿性感染的後果比慢性感染較輕微，但可從最小的變化至肝細胞癌延伸[39]。
已被治療者再度受到隱匿性感染的機率是存有爭議的，但是低[20]。40％丙型肝炎的患者顯示是負丙型肝炎血清和血清中無測出病毒基因組的患者，被測出肝中具有丙型肝炎病毒[43]。此情況發生在兒童内的機率未知[44]。
Main article: Hepatitis C virus
The hepatitis C virus (HCV) is a small, enveloped, single-stranded, positive-sense RNA virus.[6] It is a member of the Hepacivirus genus in the family Flaviviridae.[18] There are seven major genotypes of HCV, which are known as genotypes one to seven.[45] The genotypes are divided into several subtypes with the number of subtypes depending on the genotype. In the United States, about 70% of cases are caused by genotype 1, 20% by genotype 2 and about 1% by each of the other genotypes.[13] Genotype 1 is also the most common in South America and Europe.[6]
The half life of the virus particles in the serum is around 3 hours and may be as short as 45 minutes.[46][47] In an infected person, about 1012 virus particles are produced each day.[46] In addition to replicating in the liver the virus can multiply in lymphocytes.[48]
病毒學
主要文章 : [[丙型肝炎病毒]]
[[丙型肝炎病毒]]是具有包膜的單股正鏈小[[核醣體病毒]][6]。歸類於[[黃病毒科]][18]的[[肝炎病毒屬]]。丙型肝炎主要分為7個基因型，有第一到第七基因型。[45]這些基因型都分成幾個子型態，其數目取決於基因型的不同而有所差異。在美國，有70%的案件是由第一個基因型所引起，20%是第二個基因型，而另外的基因型只造成大概1%。[13]第一個基因型也普遍於南美洲與歐洲地區。[6]
血漿內病毒粒子的半衰期落在45分到3小時之間。[46][47]在於受感染的人體，每天大約會產生1012個病毒。[46]病毒的複製不限於肝臟進行，也會透過白血球而增生。[48]
The primary route of transmission in the developed world is intravenous drug use(IDU), while in the developing world the main methods are blood transfusions and unsafe medical procedures.[3] The cause of transmission remains unknown in 20% of cases;[49] however, many of these are believed to be accounted for by IDU.[15]
傳播
在[[已開發國家]]主要的傳播方式是靜脈注射藥物，而在[[發展中國家]]主要的方式是[[輸血]]和不安全的醫療程序[3]。20%案例的傳播原因不明[49]，但是很多被認為和靜脈注射藥物有關[15]。
Drug use
Intravenous drug use (IDU) is a major risk factor for hepatitis C in many parts of the world.[50] Of 77 countries reviewed, 25 (including the United States) were found to have prevalences of hepatitis C in the intravenous drug user population of between 60% and 80%.[16][50] Twelve countries had rates greater than 80%.[16] It is believed that ten million intravenous drug users are infected with hepatitis C; China (1.6 million), the United States (1.5 million), and Russia (1.3 million) have the highest absolute totals.[16] 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; this has been attributed to high-risk behavior in prisons such as IDU and tattooing with nonsterile equipment.[51][52] Intranasal drug use may also be a risk factor.[53]
吸毒
靜脈注射毒品在很多國家是感染丙型肝炎病毒的最主要風險因子[50]。在檢視的77 個國家中，25個（包括美國）國家吸毒人口的丙型肝炎盛行率高達60%至80%[16][50]；有12個國家甚至超過80%[16]。一般相信有一千萬吸毒者受丙型肝炎病毒感染：以中國（160萬）、美國（150萬）和俄羅斯（130萬）佔最多[16]。丙型肝炎在美國在囚人士的發生率是一般人口的十到二十倍，歸咎於監獄的高危行為如靜脈注射吸毒和使用未消毒的工具紋身[51][52]。以鼻腔吸毒可能也是風險因子之一[53]。
Healthcare exposure
Blood transfusion, transfusion of blood products, or organ transplants without HCV screening carry significant risks of infection.[13] The United States instituted universal screening in 1992[54] and Canada instituted universal screening in 1990.[55] This decreased the risk from one in 200 units[54] to between one in 10,000 to one in 10,000,000 per unit of blood.[15][49] This low risk remains as there is a period of about 11–70 days between the potential blood donor’s acquiring hepatitis C and the blood’s testing positive depending on the method.[49] Some countries do not screen for hepatitis C due to the cost.[23]
Those who have experienced a needle stick injury from someone who was HCV positive have about a 1.8% chance of subsequently contracting the disease themselves.[13] The risk is greater if the needle in question is hollow and the puncture wound is deep.[23] There is a risk from mucosal exposures to blood; but this risk is low, and there is no risk if blood exposure occurs on intact skin.[23]
Hospital equipment has also been documented as a method of transmission of hepatitis C, including reuse of needles and syringes; multiple-use medication vials; infusion bags; and improperly sterilized surgical equipment, among others.[23] Limitations in the implementation and enforcement of stringent standard precautions in public and private medical and dental facilities are known to be the primary cause of the spread of HCV in Egypt, the country with highest rate of infection in the world.[56]
健康照護的意外感染
沒有經過丙型肝炎病毒化驗檢測進行輸血、輸入血品輸液或器官移植的操作帶有顯著的感染風險[13] 。美國和加拿大分別在1992[54]和1990[55]年展開全面的篩檢，把風險從每200單位[54]血液就有一人受感染減低至每10,000至10,000,000單位血液才有一人受感染[15][49]。依檢測方法的不同[49]，捐血者丙型肝炎病毒血液化驗的空窗期可能有11到70天，因此即使有篩檢，仍然有感染的風險。另外，有些國家因為成本考量，沒有進行丙型肝炎病毒篩檢[23]。
被帶有丙型肝炎病毒患者使用過的針刺傷的人有大約1.8%機會染病[13]。空心的針和深的傷口連帶著更高的風險[23]。粘膜接觸也帶有風險，不過風險較低。血液碰觸到沒有傷口的皮膚不會有感染風險[23]。
醫用器材也有被記錄到成為傳播丙型肝炎的途徑，包括重複使用的針管和針筒、重複使用的藥瓶、輸液袋和沒有妥善消毒的手術用器材等。埃及的公私立醫療和牙科設施沒有實施嚴謹標準化的預防措施，這是埃及已知傳播丙型肝炎病毒的主要原因。埃及有全球最高的感染率[56]。
Sexual intercourse (嘉晉)
Whether hepatitis C can be transmitted through sexual activity is controversial.[57] While there is an association between high-risk sexual activity and hepatitis C, and multiple sexual partners are a risk factor for hepatitis C, there is no conclusive evidence that hepatitis C can be transmitted by sexual activity, since people who report transmission with sex as their only risk factor may actually have used drugs but denied it.[13] The majority of evidence supports there being no risk for heterosexual couples with only one sexual partner.[57] Sexual practices that involve higher levels of trauma to the anogenital mucosa, such as anal penetrative sex, or that occur when there is a concurrent sexually transmitted infection, including HIV or genital ulceration, do present a risk.[57] The United States Department of Veterans Affairs recommends condom use to prevent hepatitis C transmission in those with multiple partners, but not those in relationships that involve only a single partner.[58]
性交
C型肝炎是否會透過性交傳染依然是具有爭議性的[57]，雖然高風險的性交和C型肝炎確實是有連結關係且多重性伴侶是C型肝炎的風險因子，然而並沒有決定性的證據顯示C型肝炎可以透過性交來傳染，因為在受到傳染的患者中說自己只有性交這個唯一的風險因子者，事實上，可能都有使用過毒品但否認自己用過。[13]多數證據支持對於[[異性]]配偶且單一性伴侶者（性交）是沒有（傳染C型肝炎）風險。性行為對於生殖器與肛門黏膜有較高傷害程度的，例如[[肛交]]，或是恰好有[[性傳播疾病]]的（包含HIV或是[[生殖器潰瘍]]等），就有一定的風險[57] 。[[美國退伍軍人事務部]]建議多重性伴侶者使用[[保險套]]來防止C型肝炎的傳染，至於只有單一性伴侶者則沒關係。[58]
Body modification (聿修)
Tattooing is associated with two to threefold increased risk of hepatitis C.[59] This can be due to either improperly sterilized equipment or contamination of the dyes being used.[59] Tattoos or piercings performed either before the mid-1980s, "underground," or nonprofessionally are of particular concern, since sterile techniques in such settings may be lacking. The risk also appears to be greater for larger tattoos.[59] It is estimated that nearly half of prison inmates share unsterilized tattooing equipment.[59] It is rare for tattoos in a licensed facility to be directly associated with HCV infection.[60]
修飾身體 （聿修）
[[刺青]]將增加罹患Ｃ型肝炎二至三倍的風險[59]。這可能是由於使用不當的消毒設備或遭受污染的染料而造成的[59]。在一九八零年代中期之前，因為缺乏消毒技術，透過“地下行業”或者非專業者所執行的[[刺青]]或[[穿洞]]的行為令人擔憂。顯然刺青越大所帶來的風險將越大[59]。經由預估，將近半數的囚犯共同使用未經消毒的刺青設備[59]。如果透過有執照的機構進行刺青，因而罹患Ｃ型肝炎的機率非常微小[60]。
Shared personal items (聿修)
Personal-care items such as razors, toothbrushes, and manicuring or pedicuring equipment can be contaminated with blood. Sharing such items can potentially lead to exposure to HCV.[61][62] Appropriate caution should be taken regarding any medical condition that results in bleeding, such as cuts and sores.[62] HCV is not spread through casual contact, such as hugging, kissing, or sharing eating or cooking utensils.[62] Neither is it transmitted through food or water.[63]
共同使用個人貼身用品 （聿修）
個人貼身用品，例如刮鬍刀、牙刷和指甲刀等器皿可能會沾染血液。共同使用上述器皿可能帶來暴露於Ｃ型肝炎的風險[61][62]。任何導致[[流血]]、傷痕、褥瘡等醫療狀況必須採取適當的警覺[62]。Ｃ型肝炎不會透過日常生活中的接觸、例如擁抱、親吻、共享餐具或廚具而傳播[62]。亦不會透過食物與水傳播[63]。
Vertical transmission (聿修)
Vertical transmission of hepatitis C from an infected mother to her child occurs in less than 10% of pregnancies.[64] There are no measures that alter this risk.[64] It is not clear when transmission occurs during pregnancy, but it may occur both during gestation and at delivery.[49] A long labor is associated with a greater risk of transmission.[23] There is no evidence that breast-feeding spreads HCV; however, to be cautious, an infected mother is advised to avoid breastfeeding if her nipples are cracked and bleeding,[65] or if her viral loads are high.[49]
垂直傳染 （聿修）
There are a number of diagnostic tests for hepatitis C, including HCV antibodyenzyme immunoassay or ELISA, recombinant immunoblot assay, and quantitative HCV RNA polymerase chain reaction (PCR).[13] HCV RNA can be detected by PCR typically one to two weeks after infection, while antibodies can take substantially longer to form and thus be detected.[26]
現存有許多種丙型肝炎的檢測方式，其中包含了丙型肝炎[[酵素結合免疫吸附分析法(ELISA)]]、[[重組免疫墨點分析]]及及可量化的丙型肝炎[[RNA]][[聚合酶連鎖反應]]。在感染丙型肝炎後一至兩週，其病毒[[RNA]]通常即可被偵測；但抗體則需要花較長的時間形成而被測得。
Chronic hepatitis C is defined as infection with the hepatitis C virus persisting for more than six months based on the presence of its RNA.[17] Chronic infections are typically asymptomatic during the first few decades,[17] and thus are most commonly discovered following the investigation of elevated liver enzyme levels or during a routine screening of high-risk individuals. Testing is not able to distinguish between acute and chronic infections.[23] Diagnosis in the infant is difficult as maternal antibodies may persist for up to 18 months.[44]
丙型肝炎病毒感染後，藉偵測RNA表現，若丙型肝炎病毒存在持續六個月以上即被定義為慢性丙型肝炎[17]。慢性丙型肝炎在感染初期的數十年間通常沒有徵兆[17]，通常丙型肝炎的高風險患者會藉由定期的[[肝功能測試]]中測得提升的肝臟酵素量而發現罹患此疾病。然而，此測試無法區別肝炎是為急性抑是慢性感染[23]。此外，由於母體提供的抗體可作用長達十八個月，因此造成嬰兒的丙型肝炎診斷上較為困難。
Serology (中鼎)
Hepatitis C testing typically begins with blood testing to detect the presence of antibodies to the HCV, using an enzyme immunoassay.[13]If this test is positive, a confirmatory test is then performed to verify the immunoassay and to determine the viral load.[13] A recombinant immunoblot assay is used to verify the immunoassay and the viral load is determined by a HCV RNA polymerase chain reaction.[13] If there is no RNA and the immunoblot is positive, it means that the person tested had a previous infection but cleared it either with treatment or spontaneously; if the immunoblot is negative, it means that the immunoassay was wrong.[13] It takes about 6–8 weeks following infection before the immunoassay will test positive.[18] A number of tests are available as point of care testing which means that results are available within 30 minutes.[66]
Liver enzymes are variable during the initial part of the infection[17] and on average begin to rise at seven weeks after infection.[18] The elevation of liver enzymes does not closely follow disease severity.[18]
血清學
丙型肝炎的檢測首先通常以[[血液檢查]]，使用酵素免疫分析來檢測丙型肝炎抗體表現[13]。若檢查結果為陽性，進一步的檢測則會進行丙型肝炎病毒載量的檢驗[13]。[[重組免疫墨點分析]]則用於驗證酵素免疫分析結果、病毒載量則藉由[[RNA聚合酶連鎖反應(PCR)]]測量[13]。若檢測結果不具丙型肝炎病毒RNA、免疫墨點分析結果為陽性，代表受試者曾經感染過丙型肝炎，但病毒藉由治療或自身免疫系統作用而痊癒。若免疫墨點分析結果為陰性，則代表酵素免疫分析結果為誤[13]。原因是因為在丙型肝炎感染後6-8週，酵素免疫分析結果才會呈陽性。有許多其他丙型肝炎的測試，如[[床邊血糖檢測(又稱即時血糖檢測)(POCT)]]，可在三十分鐘內提供檢測結果[66]。
肝臟的酵素再感染初期會有多種變化情形[17]，平均來說在感染七週後肝臟酵素的值會提升[18]。而肝臟酵素的提升量與丙型肝炎的嚴重性並非沒有緊密相關。
Biopsy (秉宸)
Liver biopsies are used to determine the degree of liver damage present; however, there are risks from the procedure.[6] The typical changes seen are lymphocytes within the parenchyma, lymphoid follicles in portal triad, and changes to the bile ducts.[6] There are a number of blood tests available that try to determine the degree of hepatic fibrosis and alleviate the need for biopsy.[6]
切片檢查
[[肝穿刺切片檢查]]是用來確認病人目前肝臟毀損的程度；然而，這項檢查的療程具有風險[6]。典型可見的包含肝臟內部實質的[[淋巴細胞]]、[[肝門管區]]內的[[淋巴濾泡]]以及膽管的改變[6]。目前尚有一些可行的血液檢測可用以確認病人[[肝纖維化]]的程度，減少切片檢查的需求[6]。
Screening (秉宸)
It is believed that only 5–50% of those infected in the United States and Canada are aware of their status.[59] Testing is recommended for those at high risk, which includes injection drug users, those who have received blood transfusions before 1992,[67] those who have been in jail, those on long term hemodialysis,[68] and those with tattoos.[59] Screening is also recommended in those with elevated liver enzymes, as this is frequently the only sign of chronic hepatitis.[69] Routine screening is not currently recommended in the United States.[13] In 2012, the U.S. Centers for Disease Control and Prevention (CDC) added a recommendation for a single screening test for those born between 1945 and 1965.[70]
篩檢
根據統計，只有5-50％美國與加拿大的病患查知自己得到丙型肝炎的身體狀況[59]。丙型肝炎高風險族群：包含藥物注射者、在1992年前接受過輸血者[67]、曾經坐牢、長期進行[[血液透析]][68]，以及有刺青者[59]，都是被建議需要去做篩檢的族群。同時，肝功能酵素增高的病患也建議須做篩檢，因為這通常是慢性肝炎的唯一徵兆[69]。然而，在美國，例行性的篩檢卻不被推薦[13]；在2012年，美國[[疾病控制與預防中心]]新增了另一單一篩檢推薦給在1945到1965年間出生者。
As of 2016, no approved vaccine protects against contracting hepatitis C.[71] However, there are a number of vaccines under development and some have shown encouraging results.[71]
A combination of harm reduction strategies, such as the provision of new needles and syringes and treatment of substance use, decreases the risk of hepatitis C in intravenous drug users by about 75%.[72] The screening of blood donors is important at a national level, as is adhering to universal precautions within healthcare facilities.[18] In countries where there is an insufficient supply of sterilesyringes, medications should be given orally rather than via injection (when possible).[23]
預防
亦可參考：[[丙型肝炎疫苗]]
至2016年為止，尚未有核准通過的[[疫苗]]可阻止丙型肝炎傳播[71]。目前有一些研究中的疫苗顯示激勵性的結果[71]。
結合如[[新針頭、注射器相關規定]]與[[藥物使用治療]]的[[減少傷害]]對策，以降低靜脈注射使用者約75%的丙型肝炎感染風險[72]。醫療院所推行的捐血者篩選[[普遍預防措施]]更具有國家級的重要性[18]。無菌[[注射器]]供給不足的國家於可能前提之下應使用口服藥物而非透過注射給藥[23]。
有50-80%感染HCV的人會引發慢性感染，而其中大約有40-80%的感染者在治療後能康復[73][74]。有極少數的案例在沒有治療的情形下也可以完全痊癒[15]。C型肝炎的患者建議要避免[[酒精]]和會[[對於肝臟產生毒性的藥物]]，並施打[[A型肝炎]]和[[B型肝炎]]的[[疫苗]][13]。有肝硬化的患者建議可做[[肝細胞癌]]的[[超音波]]監控[13]。
HCV induces chronic infection in 50–80% of infected persons. Approximately 40–80% of these clear with treatment.[73][74] In rare cases, infection can clear without treatment.[15] Those with chronic hepatitis C are advised to avoid alcohol and medications toxic to the liver,[13] and to be vaccinated for hepatitis A and hepatitis B.[13] Ultrasound surveillance for hepatocellular carcinoma is recommended in those with accompanying cirrhosis.[13]
Medications
若病患被確診患有慢性C型肝炎，且因其他疾病死亡的風險不高，都會建議服用[[抗病毒的藥物]][75]。發生併發症風險最高的人需優先治療，併發症的風險是依據肝臟上結疤的程度[75]。最初始的治療取決於所感染的C型肝炎病毒種類[75]。
． HCV基因型1a：12週的[[雷迪帕費]]和[[索非布費]]或12-24週的[[paritaprevir]]、[[ombitasvir]]、
[[dasabuvir]]和[[瑞比達]][75]
． HCV基因型1b：12週的雷迪帕費和索非布費或12週的paritaprevir、ombitasvir和dasabuvir[75]
． HCV基因型2：12-16週的索非布費和瑞比達[75]
． HCV基因型3：12週的索非布費、瑞比達和[[長效型干擾素]][75]
． HCV基因型4：12週的雷迪帕費、索非布費，或paritaprevir、利托那韋、ombitasvir、瑞比
達，或24週的索非布費、瑞比達[75]
． HCV基因型5或6：索非布費和雷迪帕費[75]
Treatment with antiviral medication is recommended in all people with proven chronic hepatitis C who are not at high risk of dying from other causes.[75] People with the highest complication risk should be treated first, with the risk of complications based on the degree of liver scarring.[75] The initial recommended treatment depends on the type of hepatitis C virus with which a person is infected.[75]
索非布費配合瑞比達和干擾素顯示對於C型肝炎1,4,5或6型有90%為有效[76]。 索非布費配合瑞比達 顯示對於第2型和第3型有70-95%為有效，但有更高比例的副作用出現[76][77]。包含[[ledipasvir]]和索非布費的治療對於第1型有高達93-99%的成功率，但非常昂貴[78]。在第6型中，長效型干擾素和瑞比達於60-90%的案例是有效的[79]。第6型也有使用[[simeprevir]]的試驗數據[79]。
Sofosbuvir with ribavirin and interferon appears to be around 90% effective in those with genotype 1, 4, 5, or 6 disease.[76] Sofosbuvir with just ribavirin appears to be 70 to 95% effective in type 2 and 3 disease but has a higher rate of adverse effects.[76][77] Treatments that contain ledipasvir and sofosbuvir for genotype 1 has success rates of around 93 to 99% but is very expensive.[78] In genotype 6 infection, pegylated interferon and ribavirin is effective in 60 to 90% of cases.[79] There is some tentative data for simeprevir use in type 6 disease as well.[79]
在2011年之前，根據HCV[[基因型]]的種類，治療藥物是24-48週的[[長效型干擾素alpha]]和瑞比達的組合。這分別對第2型和第3型有70%和80%的治癒率，對第1型和第4型有45-70%的治癒率[77]。伴隨這些藥物的副作用是常見的，有一半的人會有[[類似流感的症狀]]，有三分之一的人會經歷情緒上的問題[13]。治療藥物在前六個月會比C型肝炎變成慢性還有效[26]。
Prior to 2011, treatments consisted of a combination of pegylated interferon alpha and ribavirin for a period of 24 or 48 weeks, depending on HCV genotype.[13] This produces cure rates of between 70 and 80% for genotype 2 and 3, respectively, and 45 to 70% for genotypes 1 and 4.[77] Adverse effects with these treatments were common, with half of people getting flu like symptoms and a third experiencing emotional problems.[13] Treatment during the first six months is more effective than once hepatitis C has become chronic.[26]
Surgery (秉宸)
Cirrhosis due to hepatitis C is a common reason for liver transplantation[26] though the virus usually (80–90% of cases) recurs afterwards.[6][80] Infection of the graft leads to 10–30% of people developing cirrhosis within five years.[81] Treatment with pegylated interferon and ribavirin post transplant decreases the risk of recurrence to 70%.[82]
手術
即使80-90％的病例在手術過後會有病毒復發的情形[6][80]，[[肝臟移植]]仍常用於治療因丙級肝炎引起肝硬化的病人[26]。肝臟移植造成10-30％的病人在五年內罹患肝硬化[81]。但在術後若接受長效型干擾素和瑞比達(ribavirin)等藥物治療能減低70％病毒復發的可能[82]。
Alternative medicine (秉宸)
Several alternative therapies are claimed by their proponents to be helpful for hepatitis C including milk thistle, ginseng, and colloidal silver.[83] However, no alternative therapy has been shown to improve outcomes in hepatitis C, and no evidence exists that alternative therapies have any effect on the virus at all.[83][84][85]
另類醫學
[[奶薊草]]、[[人蔘]]和[[膠質銀]]這些[[另類療法]]被各自的擁護者認為有助於丙型肝炎的治療[83]；然而，沒有任一另類療法顯示能改善丙級肝炎的症狀，亦無任何證據證明另類療法能對丙級肝炎病毒有任何作用[83][84][85]。
The responses to treatment is measured by sustained viral response (SVR), defined as the absence of detectable RNA of the hepatitis C virus in blood serum for at least 24 weeks after discontinuing the treatment,[86] and rapid virological response (RVR) defined as undetectable levels achieved within four weeks of treatment. Successful treatment decreases the future risk of hepatocellular carcinoma by 75%.[87]
Prior to 2012 sustained response occurs in about 40–50% in people with HCV genotype 1 given 48 weeks of treatment.[6] A sustained response is seen in 70–80% of people with HCV genotypes 2 and 3 with 24 weeks of treatment.[6] A sustained response occurs about 65% in those with genotype 4 after 48 weeks of treatment. The evidence for treatment in genotype 6 disease is sparse and what evidence there is supports 48 weeks of treatment at the same doses used for genotype 1 disease.[88]
預後
治療成效以持續性病毒學反應（SVR）測量，定義為療程停止至少24週後[[血清]]中未測出[[丙型肝炎病毒]]可檢測的[[核糖核酸]] [86]，快速病毒反應（RVR）定義為療程執行四週後核糖核酸即降低至無法測得的標準。成功治療可降低未來肝癌75%的發生率[87]。
2012年之前，40-50%具有第一型HCV基因型的病患於接受48週治療後仍有持續病毒反應[6]，70-80%具有第二或第三型HCV基因型的病患於在接受24週治療後仍有持續病毒反應[6]，65%具有第四型HCV基因型的病患於接受48週治療後仍有持續病毒反應。相較於證據支持48週治療確實對第一型HCV基因型有效，第六型HCV基因型的的相關治療證據相當稀少[88]。
It is estimated that 150–200 million people, or ~3% of the world’s population, are living with chronic hepatitis C.[7][8][89] About 3–4 million people are infected per year, and more than 350,000 people die yearly from hepatitis C-related diseases.[89] During 2010 it is estimated that 16,000 people died from acute infections while 196,000 deaths occurred from liver cancer secondary to the infection.[90] Rates have increased substantially in the 20th century due to a combination of intravenous drug abuse and reused but poorly sterilized medical equipment.[23]
Rates are high (>3.5% population infected) in Central and East Asia, North Africa and the Middle East, they are intermediate (1.5%-3.5%) in South and Southeast Asia, sub-Saharan Africa, Andean, Central and Southern Latin America, Caribbean, Oceania, Australasia and Central, Eastern and Western Europe; and they are low (<1.5%) in Asia Pacific, Tropical Latin America and North America.[8]
Among those chronically infected, the risk of cirrhosis after 20 years varies between studies but has been estimated at ~10–15% for men and ~1–5% for women. The reason for this difference is not known. Once cirrhosis is established, the rate of developing hepatocellular carcinoma is ~1–4% per year.[91]Rates of new infections have decreased in the Western world since the 1990s due to improved screening of blood before transfusion.[26]
In the United States, about 2% of people have hepatitis C,[13]with the number of new cases per year stabilized at 17,000 since 2007.[92] The number of deaths from hepatitis C has increased to 15,800 in 2008[93] and by 2007 had overtaken HIV/AIDS as a cause of death in the USA.[94] This mortality rate is expected to increase, as those infected by transfusion before HCV testing become apparent.[95] In Europe the percentage of people with chronic infections has been estimated to be between 0.13 and 3.26%.[96]
In England about 160,000 people are chronically infected.[97] Between 2006 and 2011 28,000 about 3%, received treatment.[97]
The total number of people with this infection is higher in some countries in Africa and Asia.[98] Countries with particularly high rates of infection include Egypt (22%), Pakistan (4.8%) and China (3.2%).[89] It is believed that the high prevalence in Egypt is linked to a now-discontinued mass-treatment campaign for schistosomiasis, using improperly sterilized glass syringes.[23]
流行病學
估計約有1.5-2億的人們，也就是3%的全球人口患有慢性C型肝炎[7][8][89]。每年約有3-4百萬的人感染C型肝炎，而且每年有超過35萬的人死於C型肝炎的相關疾病[89]。在2010年中，估計約有16,000人死於急性感染，同時感染伴隨而來的肝癌也造成196,000的死亡案例[90]。因為靜脈注射藥物的濫用和未消毒完全的醫療器材的重複使用也導致感染比例在20世紀中大幅增加[23]。
感染比例高的地區(感染人口>3.5%)在中亞、東亞、北非以及中東。南亞、東南亞、撒哈拉沙漠以南的非洲、安地斯山脈、中南美洲、加勒比海、大洋洲、澳大拉西亞以及中、東、西歐的比例位於中間 (1.5%-3.5%)[90]。亞太地區、熱帶拉丁美洲和北美的感染比例則比較低(<1.5%)[8]。
在感染者中，20年後[[硬化]]的風險在研究上有所不同，但估計男性有10–15%的機率，女性則是10–15%。而這種差異的原因目前仍不清楚。一旦硬化開始，發展成[[肝癌]]的比率每年增加1–4%[91]。從1990年以來，由於輸血前的檢測已獲得改善，西方的新感染者比例已逐漸下降[26]。
在美國，約有2%的人有C型肝炎[13]，從2007年以來每年穩定增加約17,000人[92]。因為C型肝炎而死亡的人數在2008年增加到 15,800 ，且在2007年底前也超越了HIV/AIDS在美國的死亡人數[94] 。此致死率預期會增加，因為在HCV檢驗陽性前的輸血感染[95]。在歐洲，長期感染的人口比例則估計介於0.13%到3.26%之間[96]。
在英國，約有160,000 人長期感染，在2006到2011年之間有28,000人，約3%接受治療[97]。
感染總數在[[非洲]]和[[亞洲]]比較多[98] 。感染比例特別高的國家包含埃及(22%)，巴基斯坦(4.8%)和中國 3.2%)[89]。人們認為埃及的高患病率和現在已經停止的[[血吸蟲病]]集體治療中未消毒的玻璃注射器有關[23]。
In the mid-1970s, Harvey J. Alter, Chief of the Infectious Disease Section in the Department of Transfusion Medicine at the National Institutes of Health, and his research team demonstrated how most post-transfusion hepatitis cases were not due to hepatitis A or Bviruses. Despite this discovery, international research efforts to identify the virus, initially called non-A, non-B hepatitis (NANBH), failed for the next decade. In 1987, Michael Houghton, Qui-Lim Choo, and George Kuo at Chiron Corporation, collaborating with Dr. D.W. Bradley at the Centers for Disease Control and Prevention, used a novel molecular cloning approach to identify the unknown organism and develop a diagnostic test.[99] In 1988, Alter confirmed the virus by verifying its presence in a panel of NANBH specimens. In April 1989, the discovery of HCV was published in two articles in the journal Science.[100][101] The discovery led to significant improvements in diagnosis and improved antiviral treatment.[99] In 2000, Drs. Alter and Houghton were honored with the Lasker Award for Clinical Medical Research for "pioneering work leading to the discovery of the virus that causes hepatitis C and the development of screening methods that reduced the risk of blood transfusion-associated hepatitis in the U.S. from 30% in 1970 to virtually zero in 2000."[102]
Chiron filed for several patents on the virus and its diagnosis.[103] A competing patent application by the CDC was dropped in 1990 after Chiron paid $1.9 million to the CDC and $337,500 to Bradley. In 1994, Bradley sued Chiron, seeking to invalidate the patent, have himself included as a coinventor, and receive damages and royalty income. He dropped the suit in 1998 after losing before an appeals court.[104]
歷史
在1970年代中期，[[美國國立衛生研究院]]輸血醫學部傳染疾病組長[[哈維·詹姆斯·阿爾特]]和他的研究團隊表示大多數[[輸血]]後肝炎病例並不是因為A或B型[[肝炎]]病毒。儘管有此發現，國際研究對於確認病毒的努力在10年內仍失敗了，而把它稱為非A非B肝炎(NANBH)。在1987年，[[Chiron 公司]]的[[麥可·霍頓]]、[[ Qui-Lim Choo]]和 George Kuo 與 D.W. Bradley博士在[[美國疾病控制與預防中心]]
合作，他們利用一種新的[[分子複製]]的技術去確認未知的生物和發展診斷檢測[99]。1988年Alter藉由校驗NANBH標本的面板確認了病毒。在1989年的春天，HCV的發現被刊登在Science期刊中的兩篇文章[100][101]。這個發現造就了診斷上的改良也改善了抗病毒的治療[99]。
See also: List of people with hepatitis C
World Hepatitis Day, held on July 28, is coordinated by the World Hepatitis Alliance.[105] The economic costs of hepatitis C are significant both to the individual and to society. In the United States the average lifetime cost of the disease was estimated at 33,407 USD in 2003[106] with the cost of a liver transplant as of 2011 costing approximately 200,000 USD.[107] In Canada the cost of a course of antiviral treatment is as high as 30,000 CAD in 2003,[108] while the United States costs are between 9,200 and 17,600 in 1998 USD.[106] In many areas of the world, people are unable to afford treatment with antivirals as they either lack insurance coverage or the insurance they have will not pay for antivirals.[109] In the English National Health Service treatment rates for hepatitis C are higher among wealthier groups per 2010-2012 data.[97]
社會與文化
亦可參考：[[丙型肝炎感染者名單]]
[[世界肝炎日]]由世界肝炎聯盟於每年七月二十八日舉行[105]。丙型肝炎所造成的經濟支出對於個人或社會皆相當可觀。2003年該疾病患者於美國的醫療平均負擔約為33,407美金[106]，加上肝臟移植至2011年上看約200,000美金[107]。2003年加拿大的抗病毒療程約為30,000加幣，1998年於美國約介於9,200-17,600美金之間[106]。許多地區的民眾因缺乏保險所持有的保險不給付而無法負擔抗病毒治療[109]。2010-2012年資料顯示英國[[國民保健署]]（NHS）丙型肝炎治療率於富裕族群中較高[97]。
As of 2011, there are about one hundred medications in development for hepatitis C.[107] These include vaccines to treat hepatitis,immunomodulators, and cyclophilin inhibitors, among others.[110] These potential new treatments have come about due to a better understanding of the hepatitis C virus.[111] The combination of sofosbuvir and velpatasvir in one trial resulted in cure rates of 99%.[112]
研究
至2011年為止，丙型肝炎約有一百種發展中的藥物治療[107]。其中包含治療肝炎的疫苗、[[免疫調節劑]]與[[環孢素]]抑制劑 [110]。這些潛在的新治療方式發展立基於對丙型肝炎病毒的進一步了解[111]。結合sofosbuvir（藥物商品名Sovaldi，病毒蛋白酶抑制劑，國內未核准上市）and velpatasvir的試驗具有99%的治癒率[112]。
Animal models
One barrier to finding treatments for hepatitis C is the lack of a suitable animal model. Despite moderate success, current research highlights the need for pre-clinical testing in mammalian systems such as mouse, particularly for the development of vaccines in poorer communities. Currently, chimpanzees remain the available living system to study, yet their use has ethical concerns and regulatory restrictions. While scientists have made use of human cell culture systems such as hepatocytes, questions have been raised about their accuracy in reflecting the body’s response to infection.[113]
One aspect of hepatitis research is to reproduce infections in mammalian models. A strategy is to introduce liver tissues from humans into mice, a technique known as xenotransplantation. This is done by generating chimeric mice, and exposing the mice HCV infection. This engineering process is known to create humanized mice, and provide opportunities to study hepatitis C within the 3D architectural design of the liver and evaluating antiviral compounds.[113] Alternatively, generating inbred mice with susceptibility to HCV would simplify the process of studying mouse models.
動物模型
缺乏合適的動物模型為丙型肝炎治療發展的一大阻礙。儘管些許成功的實驗，現今研究著重於[[鼠]]等哺乳動物系統的潛伏期測試，特別是為貧困地區發展疫苗。目前[[黑猩猩]]仍為可用的活體研究對象，但使用上伴隨著倫理問題與規範限制。科學家嘗試以肝細胞等人體細胞培養，此舉是否能準確反映人體的感染應對機制仍有部分質疑[113]。
肝炎研究的其中一面向為於哺乳動物系統中重現感染發生情境。其中一種策略為移植人類肝臟組織至老鼠身上，稱為異種器官移植。
透過培養嵌合體老鼠丙型肝炎感染暴露完成。培育擬人化小鼠以提供於肝臟的三度空間結構中研究丙型肝炎病毒的機會與評估抗病毒物質[113]。此外，採用丙型肝炎易感的同系繁殖小鼠可簡化動物模型的研究流程。
Children and pregnancy
Main article: HCV in children and pregnancy
Compared with adults, infection in children is much less well understood. Worldwide the prevalence of hepatitis C virus infection in pregnant women and children has been estimated to 1–8% and 0.05–5% respectively.[114] The vertical transmission rate has been estimated to be 3–5% and there is a high rate of spontaneous clearance (25–50%) in the children. Higher rates have been reported for both vertical transmission (18%, 6–36% and 41%).[115][116] and prevalence in children (15%).[117]
特殊族群
主要文章：[[丙型肝炎感染的幼童與懷孕婦女族群]]
相較於成人，關於幼童丙型肝炎感染的理解極少。全世界丙型肝炎盛行率懷孕婦女約為1-8%，幼童約為0.05-5%[114]。垂直感染率約為3-5%，幼童則有高發生率的自然清除（25-50%）。垂直感染（18%, 6-36%, 41%）[115][116]與幼童盛行率[117]皆高度發生。
In developed countries transmission around the time of birth is now the leading cause of HCV infection. In the absence of virus in the mother’s blood transmission seems to be rare.[116] Factors associated with an increased rate of infection include membrane rupture of longer than 6 hours before delivery and procedures exposing the infant to maternal blood.[118] Cesarean sections are not recommended. Breast feeding is considered safe if the nipples are not damaged. Infection around the time of birth in one child does not increase the risk in a subsequent pregnancy. All genotypes appear to have the same risk of transmission.
已開發國家中丙型肝炎感染主因為生產過程的傳播。母體血液無病毒的前提下，傳播極為罕見[116]。感染率提高的相關因素包含產前羊膜囊破裂超過六小時與生產過程嬰兒接觸母體血液[118]。不建議剖腹產。母乳哺育於乳頭完好無傷口的前提下是安全的。單一生產過程的感染並不會增加後續懷孕的感染風險。所有基因型皆有相同的感染機率。
HCV infection is frequently found in children who have previously been presumed to have non-A, non-B hepatitis and cryptogenic liver disease.[119] The presentation in childhood may be asymptomatic or with elevated liver function tests.[120] While infection is commonly asymptomatic both cirrhosis with liver failure and hepatocellular carcinoma may occur in childhood.
丙型肝炎感染好發於先前假定感染非A、非B型肝炎與不明肝臟疾病[119]。孩童時期可能無症狀發生或肝功能指數上升[120]。感染、孩童時期發生的肝硬化、肝功能衰竭與肝癌皆並無伴隨明顯症狀。
Immunosuppressed
See also: Hepatitis C and HIV coinfection
The rate of hepatitis C in immunosuppressed people is higher than the normal population. This is particularly true in those with human immunodeficiency virus infection, recipients of organ transplants and those with hypogammaglobulinemia.[121] Infection in these people is associated with an unusually rapid progression to cirrhosis.
免疫抑制
亦可參考：[[丙型肝炎與人類免疫缺陷病毒合併感染]]
丙型肝炎患者的免疫抑制率相較正常人口為高。其中又以[[人類免疫缺陷病毒]]感染者、接受[[器官移植]]者與[[低丙種球蛋白血症]]患者尤其如此[121]，這些患者的感染與一種不常見的快速硬化進程相關。