essay on hepatitis c in english

Hepatitis C: Prevention and Treatment Essay

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Introduction

Background of the studies, how the two studies support the nursing practice problem, methods of the studies, results of the studies, ethical considerations.

The prevention and treatment of hepatitis C are major public health concerns because many ignore the symptoms and avoid therapeutic recommendations. According to Lee et al. (2020), ignoring Hepatitis C symptoms and avoiding therapeutic recommendations resulted in an acute state despite the disease being curable. Some studies have identified people with chronic immune problems as the most vulnerable to hepatitis C contamination (Koniares et al., 2020). For example, pregnant women, children, the elderly, and people who have had liver transplants are among the most vulnerable groups (Koniares et al., 2020). Regular Hepatitis C screening can reduce the number of individuals with a chronic liver infection due to ignorance. In addition, routine screening may influence the overall efficacy of hepatitis C treatment. Universal screening can protect vulnerable groups from hepatitis C, promote timely infection diagnosis, and facilitate effective treatment plans.

PICOT Question : Compared to no screening, does obligatory screening for hepatitis C increase the timely diagnosis of the infection within 12 months in patients with immunity problems?

The section analyzes the problem statement, significance to nursing, purpose, objective, and research question of two quantitative studies. Koniares et al. (2020) study sought to determine whether universal Hepatitis C screening in pregnant women is more effective than risk-based screening. So, the study asks whether risk-based screening is as effective as universal screening. It is relevant to nursing research because it focuses on screening pregnant women who belong to the vulnerable patient group at high risk of hepatitis C contamination.

The second study evaluates the effectiveness of screening for hepatitis C among populations with immunity problems. Lee et al. (2020) intended to determine if community-based screening for hepatitis C among drug addicts can reduce the spread of infection. Therefore, the study asked whether a Hepatitis C screening test is necessary among drug addicts. Because drug addicts are among those with immune deficiencies, the study’s goal is consistent with nursing research.

The two articles are relevant to my PICOT question because they investigate Hepatitis C virus infection among vulnerable groups. For instance, Koniares et al. (2020) focused on screening pregnant women who belong to vulnerable patients with high risks of contamination with hepatitis C. The study intervention identifies critical areas where healthcare providers are inconsistent in identifying risk factors for hepatitis C virus infection. Similarly, Lee et al. (2020) evaluated the effectiveness of screening for hepatitis C among populations with immunity problems. Since screening in high-risk settings identified a substantial hepatitis C burden and the significance of reflex testing, it reinforces my research PICOT question. The study intervention that recommends hepatitis C screening to be conducted in at-risk younger groups in drug treatment centers also answers my research question.

The two studies used different methodologies to assess hepatitis C virus screening practices in high-endemic populations. Koniares et al. (2020) used the survey method, whereas Lee et al. (2020) used the experimental method. A 10-question electronic survey was sent to residents and attending physicians who provide obstetrical care (Koniares et al., 2020). The experimental research was conducted between 2016 and 2018 in shelters, drug treatment centers, and Federally Qualified Health Centers that engaged in the screening. It took a coordinator to help people confirm their viremia and connect with substance abuse treatment or primary care providers who prescribe hepatitis C medication (Lee et al., 2020). The experiment results from all stations were analyzed to determine the efficacy of screening in high-risk settings.

Surveys have a high level of general capability in representing a large population. Data collected via the survey method provide a more accurate description of the relative characteristics of the study population (Nayak & Narayan, 2019). Nevertheless, it is possible to use inappropriate questions in surveys because of the need to accommodate everyone. An experimental research method is more accurate because it allows for a high degree of control. For example, researchers can isolate specific variables with this method, making it possible to make a precise conclusion or determine if a potential outcome is viable. However, experiment results are highly subjective due to the possibility of human error. Any error, whether systematic or random, would render the results invalid.

The study finding shows a strong correlation between screening and Hepatitis C detection in vulnerable groups. For instance, the Koniares et al. (2020) survey showed that risk-based screening for the Hepatitis C virus might be less effective than universal screening because healthcare providers are inconsistent in identifying risk factors. Universal screening might reduce the number of Hepatitis C virus infections that go undetected during pregnancy. The finding is crucial in nursing practice because it provides valuable information on the need for universal screening for pregnant women.

The second study evaluated the effectiveness of community-based test programs for people at drug treatment centers. Results indicated that drug addicts are high-risk and should be tested for Hepatitis C on visiting healthcare facilities (Lee et al., 2020). The results raised awareness in nursing practice about the importance of focusing on high-risk groups (drug users), typically ignored by public health. Nurses should keep these vulnerable patients in mind as they strive to create a society free of Hepatitis C.

Getting approval for your study is one example of ethical consideration in any research involving data collection with people. Review boards or other responsible authorities must determine if the research goals and design are ethical or follow your institution’s code of conduct. Koniares et al. (2020) followed this guideline by submitting their proposal to the Tufts Medical Center Institutional Review Board for approval. Similarly, Lee et al. (2020) presented their study for approval by the University of Alabama at Birmingham (UAB) review board. These studies followed the correct procedure in seeking permission from the appropriate authorities.

Voluntary participation is another ethical consideration that is crucial in research involving subjects. Research subjects are free to choose to participate without any pressure or coercion (Kaewkungwal & Adams, 2019). Lee et al. (2020) required frontline workers to inform patients that free and confidential HCV antibody testing would be administered unless they declined. Similarly, Koniares et al. (2020) emailed the surveys to residents and attending physicians based on mutual consent. Therefore, participants in both studies were aware of their rights to withdraw or continue participation.

Ignoring the symptoms of Hepatitis C and ignoring therapeutic recommendations will always result in an acute state of the virus infection. Those at risk for Hepatitis C infections include pregnant women, children, the elderly, and those who have received a liver transplant. Lee et al. (2020) and Koniares et al. (2020) evaluated the efficacy of universal Hepatitis C screening among drug addicts and pregnant women, respectively. The findings suggest that regular Hepatitis C screening increases the detection of virus infections that go undetected during pregnancy or among drug addicts. The studies identify critical areas in which providers are inconsistent in identifying risk factors and crucial information for nursing practice. In addition, both studies adhere to ethical considerations, such as obtaining approval from the appropriate authorities and the subjects’ informed consent.

Kaewkungwal, J., & Adams, P. (2019). Ethical consideration of the research proposal and the informed-consent process: An online survey of researchers and ethics committee members in Thailand. Accountability in Research , 26 (3), 176-197. Web.

Koniares, K., Fadlallah, H., Kolettis, D., & Vindenes, T. (2020). Hepatitis C virus screening in pregnancy. American Journal of Obstetrics & Gynecology MFM , 2(3), 100-123. Web.

Lee, A., Karumberia, S., Gilmore, A., Williams, E., Bruner, N., Overton, E., Saag, M, & Franco, R. (2020). Hepatitis C among high-risk Alabamians: Disease burden and screening effectiveness. The Journal of Infectious Diseases , 222(5), 365-375. Web.

Nayak, M., & Narayan, K. (2019). Strengths and weaknesses of online surveys. IOSR Journal of Humanities and Social Sciences , 24(5), 31-38. Web.

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IvyPanda. (2023, November 29). Hepatitis C: Prevention and Treatment. https://ivypanda.com/essays/hepatitis-c-prevention-and-treatment/

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Hepatitis C

• Hepatitis C is an inflammation of the liver caused by the hepatitis C virus.
• The virus can cause both acute and chronic hepatitis, ranging in severity from a mild illness to a serious, lifelong illness including liver cirrhosis and cancer.
• The hepatitis C virus is a bloodborne virus and most infection occur through exposure to blood from unsafe injection practices, unsafe health care, unscreened blood transfusions, injection drug use and sexual practices that lead to exposure to blood.
• Globally, an estimated 50 million people have chronic hepatitis C virus infection, with about 1.0 million new infections occurring per year.
• WHO estimated that in 2022, approximately 242 000 people died from hepatitis C, mostly from cirrhosis and hepatocellular carcinoma (primary liver cancer).
• Direct-acting antiviral medicines (DAAs) can cure more than 95% of persons with hepatitis C infection, but access to diagnosis and treatment is low.
• There is currently no effective vaccine against hepatitis C.

Hepatitis C is a viral infection that affects the liver. It can cause both acute (short term) and chronic (long term) illness. It can be life-threatening.

Hepatitis C is spread through contact with infected blood. This can happen through sharing needles or syringes, or from unsafe medical procedures such as blood transfusions with unscreened blood products.

Symptoms can include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine and yellowing of the skin or eyes (jaundice).

There is no vaccine for hepatitis C, but it can be treated with antiviral medications.

Early detection and treatment can prevent serious liver damage and improve long-term health.

Acute HCV infections are usually asymptomatic and most do not lead to a life-threatening disease. Around 30% (15–45%) of infected persons spontaneously clear the virus within 6 months of infection without any treatment.

The remaining 70% (55–85%) of persons will develop chronic HCV infection. Of those with chronic HCV infection, the risk of cirrhosis ranges from 15% to 30% within 20 years.

Geographical distribution

Hepatitis C virus infection occurs in all WHO regions. The highest burden of disease is in the Eastern Mediterranean Region with 12 million people chronically infected. In the South-East Asia Region (9 million), European Region (9 million) and the Western Pacific Region (7 million) people are chronically infected. Eight million people are chronically infected in the African Region and 5 million the Region of the Americas.

Transmission

The hepatitis C virus is a bloodborne virus. It is most commonly transmitted through:

• the reuse or inadequate sterilization of medical equipment, especially syringes and needles in healthcare settings;
• the transfusion of unscreened blood and blood products; and
• injecting drug use through the sharing of injection equipment.

HCV can be passed from an infected mother to her baby and via sexual practices that lead to exposure to blood (for example, people with multiple sexual partners and among men who have sex with men); however, these modes of transmission are less common.

Hepatitis C is not spread through breast milk, food, water or casual contact such as hugging, kissing and sharing food or drinks with an infected person.

Most people do not have symptoms in the first weeks after infection. It can take between two weeks and six months to have symptoms.

When symptoms do appear, they may include:

• feeling very tired
• loss of appetite
• nausea and vomiting
• abdominal page
• pale faeces
• jaundice (yellowing of the skin or eyes).

Testing and diagnosis

Because new HCV infections are usually asymptomatic, few people are diagnosed when the infection is recent. In those people who develop chronic HCV infection, the infection is often undiagnosed because it remains asymptomatic until decades after infection when symptoms develop secondary to serious liver damage.

HCV infection is diagnosed in 2 steps:

• Testing for anti-HCV antibodies with a serological test identifies people who have been infected with the virus.
• If the test is positive for anti-HCV antibodies, a nucleic acid test for HCV ribonucleic acid (RNA) is needed to confirm chronic infection and the need for treatment. This test is important because about 30% of people infected with HCV spontaneously clear the infection by a strong immune response without the need for treatment. Although no longer infected, they will still test positive for anti-HCV antibodies. This nucleic acid for HCV RNA can either be done in a lab or using a simple point-of-care machine in the clinic.
• Innovative new test such as HCV core antigen are in the diagnostic pipeline and will enable a one-step diagnosis of active hepatitis C infection in the future.

After a person has been diagnosed with chronic HCV infection, an assessment should be conducted to determine the degree of liver damage (fibrosis and cirrhosis). This can be done by liver biopsy or through a variety of non-invasive tests. The degree of liver damage is used to guide treatment decisions and management of the disease.

Early diagnosis can prevent health problems that may result from infection and prevent transmission of the virus. WHO recommends testing people who may be at increased risk of infection.

In settings with high HCV antibody seroprevalence in the general population (defined as > 2% or > 5% HCV antibody seroprevalence), WHO also recommends blood donor screening, as well as focused or targeted testing of specific high-risk groups, including migrants from endemic regions, health-care workers, people who inject drugs (PWID), people in prisons and other closed settings, men who have sex with men (MSM), sex workers and HIV-infected persons.

 WHO recommends that all adults have access to and be offered HCV testing with linkage to prevention, care and treatment services.

About 2.3 million people of the estimated 39 million living with HIV globally have serological evidence of past or present HCV infection. Chronic liver disease represents a major cause of morbidity and mortality among persons living with HIV globally.

There are effective treatments for hepatitis C. The goal of treatment is to cure the disease and prevent long-term liver damage.

Antiviral medications, including sofosbuvir and daclatasvir, are used to treat hepatitis C. Some people's immune system can fight the infection on their own and new infections do not always need treatment. Treatment is always needed for chronic hepatitis C.

People with hepatitis C may also benefit from lifestyle changes, such as avoiding alcohol and maintaining a healthy weight. With proper treatment, many people can be cured from hepatitis C infection and live healthy lives.

WHO recommends therapy with pan-genotypic direct-acting antivirals (DAAs) for all adults, adolescents and children down to 3 years of age with chronic hepatitis C infection. The short-course oral, curative DAA treatment regimens has few if any side-effects. DAAs can cure most persons with HCV infection, and treatment duration is short (usually 12 to 24 weeks), depending on the absence or presence of cirrhosis. In 2022, WHO included new recommendations for treatment of adolescents and children using the same pangenotypic treatments used for adults.  

Pan-genotypic DAAs remain expensive in many high- and upper-middle-income countries. However, prices have dropped dramatically in many countries (primarily low-income and lower-middle-income countries) due to the introduction of generic versions of these medicines. The most widely used and low-cost pangenotypic DAA regimen is sofosbuvir and daclatasvir. In many low- and middle-income countries the curative treatment course is available for less than US$ 50.

Access to HCV treatment is improving but remains limited. Of the 50 million people living with HCV infection globally in 2022, an estimated 36% people knew their diagnosis, and of those diagnosed with chronic HCV infection, around 20% (12.5 million) people had been treated with DAAs by the end of 2022.

Service Delivery

Until recently, delivery of hepatitis C testing and treatment in many countries relied on specialist-led (usually by a hepatologist or gastroenterologist) care models in hospital settings to administer complex treatment. With the short-course oral, curative pangenotypic HCV DAA treatment regimens with few if any side-effects, minimal expertise and monitoring are now required. WHO recommends that testing, care and treatment for persons with chronic hepatitis C infection can be provided by trained non-specialist doctors and nurses, using simplified service delivery that includes decentralization, integration and task shifting. This can be done in primary care, harm reduction services and prisons which is more accessible and convenient for patients.

Testing, care and treatment can now also be provided safely in primary care, harm reduction services and prisons which is more accessible and convenient for patients.

There is no effective vaccine against hepatitis C. The best way to prevent the disease is to avoid contact with the virus.

Extra care should be used in healthcare settings and for people with a higher risk of hepatitis C virus infection.

People at higher risk include those who inject drugs, men who have sex with men, and those living with HIV.

Ways to prevent hepatitis C include:

• safe and appropriate use of healthcare injections
• safe handling and disposal of needles and medical waste
• harm-reduction services for people who inject drugs, such as needle exchange programs, substance use counselling and use of opiate agonist therapy (OAT)
• testing of donated blood for the hepatitis C virus and other viruses
• training of health personnel
• practicing safe sex by using barrier methods such as condoms.

WHO response

Global health sector strategies on, respectively, HIV, viral hepatitis, and sexually transmitted infections for the period 2022–2030 (GHSSs) guide the health sector in implementing strategically focused responses to achieve the goals of ending AIDS, viral hepatitis (especially chronic hepatitis B and C) and sexually transmitted infections by 2030.

The GHSS recommend shared and disease-specific country actions supported by actions by WHO and partners. They consider the epidemiological, technological, and contextual shifts of previous years, foster learnings across the disease areas, and create opportunities to leverage innovations and new knowledge for effective responses to the diseases. They call to scale up prevention, testing and treatment of viral hepatitis with a focus to reach populations and communities most affected and at risk for each disease, as well as addressing gaps and inequities. They promote synergies under a universal health coverage and primary health care framework and contribute to achieving the goals of the 2030 Agenda for Sustainable Development.

WHO organizes annual World Hepatitis Day campaigns to increase awareness and understanding of viral hepatitis. For World Hepatitis Day 2023, WHO focuses on the theme “One life, one liver” to illustrate the importance of the liver for a healthy life and the need to scale up viral hepatitis prevention, testing and treatment to prevent liver diseases and achieve the 2030 hepatitis elimination target.

Global hepatitis report, 2024

World Hepatitis Day

Global health sector strategy on viral hepatitis

Guidelines & manuals

• Updated recommendations on treatment of adolescents and children with chronic HCV infection, and HCV simplified service delivery and diagnostics
• Accelerating access to hepatitis C diagnostics and treatment
• Recommendations and guidance on hepatitis C virus self-testing
• Access to hepatitis C testing and treatment for people who inject drugs and people in prisons: a global perspective
• Monitoring and evaluation of hepatitis B and C
• Manual for the development of national viral hepatitis plans

More about hepatitis

• WHO's work on hepatitis
• Global Hepatitis Programme
• Updated recommendations on simplified service delivery and diagnostics for hepatitis C infection
• Updated recommendations on treatment of adolescents and children with chronic HCV infection
• All WHO hepatitis publications

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Hepatitis C, Essay Example

Pages: 3

Words: 710

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In fact, Hepatitis C is a liver disease, which is caused by Hepatitis C virus, so called HCV infection. “HCV infection sometimes results in an acute illness, but most often becomes a chronic condition that can lead to cirrhosis of the liver and liver cancer.”(CDC, 2007) Hepatitis C is also a general term for the liver’s inflammation caused by certain infection. It can also be caused by excessive exposure to alcohol, some medications, chemicals, poisons, as well as other toxins. This virus is considered to be very dangerous, predominantly because there is no vaccine against it and it cannot be cured. “35,000-40,000 new infections every year, the majority of which are symptom free.”(Askari & Cutler, 1999)

HCV is a contagious virus, like other viruses that cause hepatitis, but it is not essentially related to them. Hepatitis C virus is primarily transmitted through contact with blood or its products. For example, the sharing of contaminated needles could be the most probable mode of transmission. Other possible cases of virus transmission could be transfusion with infected blood or blood products, or organs transplantation from infected donors. In the year 1992, a test appeared for checking patients’ blood in order to avoid contamination. However, the virus does not transmit when living with or touching someone who is infected, but you can get the disease by sharing a razor, nail clippers or other similar items.

Even though hepatitis C gradually damages the liver, “Nine out of 10 infected people are not aware of their diagnosis.” (Askari & Cutler, 1999) The symptoms may not appear for 10-20 years or even more. However, when the symptoms do appear, the damage inflicted by a virus can be very serious. The symptoms can develop in 5 to 12 weeks after exposure to HCV infection. Among the symptoms of hepatitis C virus infection there are nausea, vomiting, diarrhea, loss of appetite, fatigue, pain over the liver, jaundice, dark-colored urine, and grayish or clay colored stools. Dehydration can also be caused by nausea and vomiting. Chronic hepatitis C can also cause the cirrhosis of the liver, when healthy liver tissue is replaced by fibrous tissue that results in scarlike hardening.

The development of hepatitis C infection in human organism involves four stages: acute stage, chronic stage, compensated cirrhosis, and decompensated cirrhosis. Acute phase comes immediately after infection and last about six months. The organism is given a chance to clear the virus, but if it does not happen, then the disease moves to another stage of long-term or chronic hepatitis C. “The 70% to 85% of individuals who do not manage to clear the virus spontaneously in the acute phase of infection are considered to be in the chronic phase of hepatitis C.”(Hepatitis C Trust, 2008) The diagnosis of chronic hepatitis C is usually confirmed after positive HCV antibody testing. At this stage it is highly unlikely that the virus can be cleared without medical interference. The development of cirrhosis differs from person to person, thus some people can develop it in less than ten years, and for some individuals the process may take up to fifty years. When it gets to cirrhosis stage, it means that the process of scarring of the liver has begun, thus the usual smooth texture of the liver eventually becomes lumpy and nodular. Compensated cirrhosis means that the liver can still recover the damage and perform most of its functions. However, when it comes to decompensated cirrhosis, there is a high risk of life threatening complication, for the liver at this stage is covered with nodules and shrinks in size.

Hepatitis C is a very dangerous disease, which at certain point can result in lethal issues. However, almost half of the people being infected do not know about the infection, which makes it difficult to prevent. With the development of medicine and appearance of diagnostic systems the problem seems to be more vivid and workable. I believe, people will eventually find the vaccine against Hepatitis C, which will save millions of lives.

Department of Health and Human Services. (2007). Viral Hepatitis . Retrieved May 7, 2009, from http://www.cdc.gov/hepatitis/

Askari, F. K., & Cutler, D. S. (1999). Hepatitis C, the silent epidemic: The authoritative guide. Perseus Publishing.

Hepatitis C Trust. (2008). Progression and stages of hepatitis C . Retrieved May 7, 2009, from http://www.hepctrust.org.uk/hepatitis-c/

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• Patient Care & Health Information
• Diseases & Conditions
• Hepatitis C

The liver is the largest internal organ in the body. It's about the size of a football. It sits mainly in the upper right portion of the stomach area, above the stomach.

Hepatitis C is a viral infection that causes liver swelling, called inflammation. Hepatitis C can lead to serious liver damage. The hepatitis C virus (HCV) spreads through contact with blood that has the virus in it.

Newer antiviral medicines are the treatment of choice for most people with the ongoing, called chronic, hepatitis C infection. These medicines often can cure chronic hepatitis C.

But many people with hepatitis C don't know they have it. That's mainly because symptoms can take decades to appear. So, the U.S. Preventive Services Task Force recommends that all adults ages 18 to 79 years be screened for hepatitis C.

Screening is for everyone, even those who don't have symptoms or known liver disease.

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• A Book: Mayo Clinic on Digestive Health

Every long-term hepatitis C infection starts with what's called an acute phase. Acute hepatitis C usually isn't diagnosed because it rarely causes symptoms. When there are symptoms in this phase, they may include jaundice, fatigue, nausea, fever and muscle aches.

Long-term infection with the hepatitis C virus is called chronic hepatitis C. Chronic hepatitis C usually has no symptoms for many years. Symptoms appear only after the virus damages the liver enough to cause them.

Symptoms can include:

• Bleeding easily.
• Bruising easily.
• Not wanting to eat.
• Yellowing of the skin, called jaundice. This might show up more in white people. Also, yellowing of the whites of the eyes in white, Black and brown people.
• Dark-colored urine.
• Itchy skin.
• Fluid buildup in the stomach area, called ascites.
• Swelling in the legs.
• Weight loss.
• Confusion, drowsiness and slurred speech, called hepatic encephalopathy.
• Spiderlike blood vessels on the skin, called spider angiomas.

Acute hepatitis C infection doesn't always become chronic. Some people clear the infection from their bodies after the acute phase. This is called spontaneous viral clearance. Antiviral therapy also helps clear acute hepatitis C.

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Hepatitis C infection is caused by the hepatitis C virus (HCV). The infection spreads when blood that has the virus enters the bloodstream of a person who isn't affected.

Around the world, hepatitis C infection exists in several forms, called genotypes. There are seven genotypes and 67 subtypes. The most common hepatitis C genotype in the United States is type 1.

Chronic hepatitis C follows the same course no matter what the genotype of the infecting virus. But treatment can vary depending on viral genotype. However, newer antiviral drugs can treat many genotypes.

More Information

Hepatitis C care at Mayo Clinic

• Hepatitis C: How common is sexual transmission?

Risk factors

Screening for hepatitis c.

The U.S. Preventive Services Task Force recommends that all adults ages 18 to 79 years be screened for hepatitis C. Screening is very important for people at high risk of exposure. This includes:

• Anyone who has ever injected, snorted or inhaled an illegal drug.
• Anyone who has atypical liver test results in which the cause wasn't found.
• Babies born from someone who has hepatitis C.
• Pregnant people during the pregnancy.
• Health care and emergency workers who have been in contact with blood or been stuck by a needle.
• People with hemophilia who were treated with clotting factors before 1987.
• People who have had long-term hemodialysis.
• People who got donated blood or organ transplants before 1992.
• Sexual partners of anyone diagnosed with hepatitis C infection.
• People with HIV infection.
• Men who have sex with men.
• Sexually active people about to start taking medicine to prevent HIV , called pre-exposure prophylaxis or PrEP .
• Anyone who has been in prison.

Complications

Healthy liver vs. liver cirrhosis

A healthy liver, at left, shows no signs of scarring. In cirrhosis, at right, scar tissue replaces healthy liver tissue.

Liver cancer

Liver cancer begins in the liver cells. The most common type of liver cancer starts in cells called hepatocytes and is called hepatocellular carcinoma.

Hepatitis C infection that continues over many years can cause serious complications, such as:

• Scarring of the liver, called cirrhosis. Scarring can occur after decades of hepatitis C infection. Liver scarring makes it hard for the liver to work.
• Liver cancer. A small number of people with hepatitis C infection get liver cancer.
• Liver failure. A lot of scarring can cause the liver to stop working.
• Hepatitis C: What happens in end-stage liver disease?

The following might protect from hepatitis C infection:

• Stop using illegal drugs. If you use illegal drugs, seek help.
• Be careful about body piercing and tattooing. For piercing or tattooing, look for a shop that's known to be clean. Ask questions about how the equipment is cleaned. Make sure the employees use sterile needles. If employees won't answer questions, look for another shop.
• Practice safer sex. Don't have sex without protection with any partner whose health status you don't know. Don't have sex with more than one partner. The risk of couples who only have sex with each other getting hepatitis C through sex is low.
• Why isn't there a hepatitis C vaccine?

Living with hepatitis c?

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• Hepatitis C questions and answers for health professionals. Centers for Disease Control and Prevention. https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm. Accessed March 1, 2023.
• Screening for hepatitis C virus infection in adolescents and adults: U.S. Preventive Services Task Force recommendation statement. Journal of the American Medical Association. 2020; doi:10.1001/jama.2020.1123.
• Chopra S, et al. Overview of the management of chronic hepatitis C virus infection. https://www.uptodate.com/contents/search. Accessed March 1, 2023.
• HCV guidance: Recommendations for testing, managing, and treating hepatitis C. American Association for the Study of Liver Diseases and the Infectious Diseases Society of America. https://www.hcvguidelines.org/. Accessed May 1, 2023.
• AskMayoExpert. Hepatitis C (adult). Mayo Clinic; 2021.
• Ferri FF. Hepatitis C. In: Ferri's Clinical Advisor 2023. Elsevier; 2023. https://www.clinicalkey.com. Accessed March 1, 2023.
• Definition and facts of liver transplant. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/liver-disease/liver-transplant/definition-facts. Accessed March 1, 2023.
• Ami T. Allscripts EPSi. Mayo Clinic. March 24, 2023.
• Drinking after hepatitis C cure: Is it safe?
• New Hep C Treatment

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• Mayo Clinic Minute: What is hepatitis C? March 11, 2024, 03:15 p.m. CDT

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Hepatitis C Public Resources

At a glance.

CDC has compiled these resources to help people learn more about hepatitis C. Read and download these fact sheets, posters, and educational materials on prevention, symptoms, and treatment.

What's included

The resources on this page are designed to help you learn more about the impact hepatitis C has on public health, who’s at risk, and how to prevent infection. These links include information from CDC and other public health partners.

Fact sheets

General information on hepatitis c.

This fact sheet provides basic information on hepatitis C.

Hepatitis C and injection drug use

This fact sheet provides information on how hepatitis C can be spread through injection drug use, as well as ways to prevent hepatitis C.

These posters provide basic information on hepatitis C and promote the importance of testing.

Why should you get tested for hepatitis C?

This one-page poster promotes the importance of hepatitis C testing.

8.5" x 11" (Orange)

Poster-FactsPurple-8.5x11

Poster-FactsOrange-18x24

Poster-FactsPurple-18x24

24" x 36" (Orange)

Poster-FactsPurple-24x36

Get tested for hepatitis C

This one-page poster promotes hepatitis C testing for everyone.

Millions of Americans have hepatitis C. Many don’t know it.

This one-page poster promotes hepatitis C testing for all adults.

CDC recommends hepatitis C testing

This infographic provides information on who should be tested for hepatitis C.

Recommendation for Hepatitis C Testing | CDC

Other federal resources

• This resource from the Department of Veterans Affairs (VA) provides information on hepatitis C.
• This resource from the National Institutes of Health (NIH) provides information on hepatitis C.

Hepatitis C

Learn more about hepatitis C, a liver disease caused by the hepatitis C virus (HCV). Find HCV information for the public and health professionals.

For Everyone

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Home — Essay Samples — Nursing & Health — Blood — Hepatitis C: Causes, Treatment

Hepatitis C: Causes, Treatment

• Categories: Blood Hepatitis C

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Published: Dec 18, 2018

Words: 481 | Page: 1 | 3 min read

• Draining effectively.
• Wounding effectively.
• Poor craving.
• Yellow staining of the skin and eyes (jaundice).
• Irritated skin.
• Liquid development in your guts (ascites).
• Swelling in your legs.
• Weight reduction.
• How destroy your liver is.
• If the person have another health problem.
• The amount of the virus you have inside your body.
• What kind of (genotype) of hepatitis C you have.

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Hepatitis C: Causes, Symptoms and Treatments

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• American Liver Foundation (2017). Diagnosing Hepatitis C . Retrieved from: https://liverfoundation.org/for-patients/about-the-liver/diseases-of-the-liver/hepatitis-c/diagnosing-hepatitis-c/#signs-symptoms
• American Liver Foundation (2019). The Progression of Liver Disease. Retrieved from: https://liverfoundation.org/for-patients/about-the-liver/the-progression-of-liver-disease/#1503432878616-a25d5b59-3a75
• Aspinall, E.J., Corson, S., Doyle, J.S., Grebely, J., Hutchinson, S.J., Dore, G.J., Goldberg, D.J., & Hellard, M.E. (2013). Treatment of hepatitis C virus infection among people who are actively injecting drugs: a systematic review and meta-analysis. Clinical Infectious Disease, 57 (2). doi: 10.1093/cid/cit306.
• Barua, S., Greenwald, R., Grebely, J., Dore, G.J., Swan, T., & Taylor, L.E. (2015)  Restrictions for Medicaid reimbursement of sofosbuvir for the treatment of hepatitis C virus infection in the United States. Ann Intern Med , 163:215–23.
• Centers for Disease Control and Prevention (2013). Hepatitis C: Information on Testing & Diagnosis. Retrieved from: https://www.cdc.gov/hepatitis/HCV/PDFs/HepCTesting-Diagnosis.pdf
• Centers for Disease Control and Prevention (2019a). Hepatitis C Questions and Answers for Health Professionals. Retrieved from: https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm#a3
• Centers for Disease Control and Prevention (2019b). Hepatitis C Questions and Answers for the Public. Retrieved from: https://www.cdc.gov/hepatitis/hcv/cfaq.htm
• Fergusson, I.F. & Williams, B.R. (2016). The Trans-Pacific Partnership (TPP): Key Provisions and Issues for Congress. Retrieved from: https://fas.org/sgp/crs/row/R44489.pdf
• Ghany, M. G., Strader, D. B., Thomas, D. L., & Seeff, L. B. (2009). Diagnosis, management,and treatment of hepatitis C: an update. Hepatology (Baltimore, Md.) , 49 (4), 1335–1374. https://doi.org/10.1002/hep.22759
• Gilead Sciences (2015). Sovaldi ® Prescribing Information. Retrieved from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/204671s004lbl.pdf
• Gritsenko, D., & Hughes, G. (2015). Ledipasvir/Sofosbuvir (harvoni): improving options for hepatitis C virus infection. P&T: A Peer-Reviewed Journal for Managed Care & Formulary Management , 40 (4), 256–276. Retrieved from: https://search.ebscohost.com/login.aspx?direct=true&AuthType=sso&db=jlh&AN=10971 9989&site=eds-live&scope=site
• Henry, B. (2018) Drug Pricing & Challenges to Hepatitis C Treatment Access. Journal of Health and Biomedical Law, 14, 265-283.
• Hill, A., Khoo, S., Fortunak, J., Simmons, B., & Ford, N. (2014).  Minimum costs for producing hepatitis C direct acting antivirals, for use in large-scale treatment access programs in developing countries. Clin Infect Dis , 58 :928–36.
• Kohli, A., Shaffe,  A., Sherman,A., &  Kottilil, S.(2014). Treatment of hepatitis C: a systematic review. JAMA, 312:631–40.
• Lavanchy, D. (2011). Evolving epidemiology of hepatitis C virus. Clinical Microbiology and Infection , 17 (2), 107–115. https://doi.org/10.1111/j.1469-0691.2010.03432.x
• Lomberk, M., & Klibanov, O. M. (2015). Sofosbuvir (Sovaldi) for hepatitis C virus. Nurse Practitioner , 40 (9), 16–19. https://doi.org/10.1097/01.NPR.0000470360.31332.54
• National Institute of Diabetes and Digestive and Kidney Diseases (2019). Cirrhosis. Retrieved from: https://www.niddk.nih.gov/health-information/liver-disease/cirrhosis
• Omland, L. H., Osler, M., Jepsen, P., Krarup, H., Weis, N., Christensen, P. B., … Obel, N. (2013). Socioeconomic status in HCV infected patients – risk and prognosis. Clinical Epidemiology, 5, 163–172. https://doi.org/10.2147/CLEP.S43926
• Sai, Z., Bastian, N. D., & Griffin, P. M. (2015). Cost-effectiveness of sofosbuvir-based treatments for chronic hepatitis C in the US. BMC Gastroenterology , 15 (1), 1–9. https://doi.org/10.1186/s12876-015-0320-4
• San Francisco Department of Public Health (2019). Hepatitis C. Retrieved from: https://www.sfcdcp.org/infectious-diseases-a-to-z/hepatitis-c/
• Trooskin, S. B., Reynolds, H., & Kostman, J. R. (2015). Access to Costly New Hepatitis C Drugs: Medicine, Money, and Advocacy. Clinical Infectious Diseases: An Official Publication Of The Infectious Diseases Society Of America , 61 (12), 1825–1830. https://doi.org/10.1093/cid/civ677
• U.S. Food & Drug Administration (2018). Food and Drug Administration Safety and Innovation Act (FDASIA). Retrieved from: https://www.fda.gov/regulatory-information/selected-amendments-fdc-act/food-and-drug-administration-safety-and-innovation-act-fdasia
• World Health Organization (2019). Hepatitis C. Retrieved from: https://www.who.int/news- room/fact-sheets/detail/hepatitis-c

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The scientific progress and prospects of hepatitis C research from 2013 to 2022

Xiaowei tang.

1 Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China

2 Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China

3 Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China

Peiling Gan

4 Department of Gastroenterology, The People’s Hospital of Lianshui, Huaian, Jiangsu, China

Huifang Xia

Enqiang linghu.

Background and objective: Hepatitis C (HC) is a global health issue, with an estimated 350,000 people dying annually from this liver-related disease. This study determined the development trends and research hotspots regarding HC by investigating the related articles within the past ten years. Methods: Publications on HC were retrieved from the Web of Science Core Collection (WoSCC) on June 6, 2022. Bibliometric visualization was conducted through VOSviewer and CiteSpace. Original articles and reviews served as the foundation for this analytical research. Results: Of the total 17,773 records of HC research published from 2013 to 2022, the top 1,000 articles were retrieved and distributed among 78 countries and 270 journals. The US, where 7 of the top 10 institutions were located, mainly contributed to the study (51.9%). Johns Hopkins University distributed the most related articles (45 articles). Hepatology (IF 2021 = 17.298) ranked first, with 109 articles in the top 10 journals. Dore GJ was the most productive author (40 articles). The keywords of sustained virologic response, therapy, sofosbuvir, cirrhosis, ledipasvir, and hepatocellular carcinoma offered hints regarding research hotspots. The burst keywords regarding the virus, like HCV, HIV, and care and intervention showed as research frontiers. Conclusions: Treatment has been a trending topic in HC research, and future research may focus more on HCV and HIV co-infection, treatment, and elimination of HC.

Introduction

Hepatitis C (HC) is a type of liver inflammation caused by the hepatitis C virus (HCV), with an estimated liver-related mortality of 350,000 individuals each year [ 1 ]. Globally, nearly 170 million people are estimated to be infected with HCV, with Asian countries accounting for more than 40% of infected cases [ 2 ]. Geographically, the global distribution of the HCV genotype differs. For example, Genotype 1 (GT1) is predominant in the USA, Europe, Australia, and Japan, Genotype 3 (GT3) is more prevalent in Pakistan, whereas Genotype 4 (GT4) is the most common in Egypt and North Africa [ 3 - 5 ]. Although some acute HCV infection is self-limiting, 60-80% of these patients develop a chronic condition when the virus overcomes the host’s innate and adaptive immune defenses [ 6 - 9 ].

Liver disease is the most common and severe complication in patients chronically infected with HC. In such cases, the rate of progression to cirrhosis may also vary according to geographical location. In the USA and Europe, the rate of progression to cirrhosis within 20-30 years is approximately 15%, and the annual incidence of hepatocellular carcinoma (HCC) ranges from 1-4% [ 10 - 13 ]. However, in Japan, the rate of progression to cirrhosis in HC is higher, ranging from 30-46% [ 14 ].

As a global health challenge, HC requires a high-burden treatment option for patients, healthcare systems, and governments. Therefore, the Global Health Sector Strategy was adopted in 2016, proposing the elimination of HC infection by 2030 [ 15 ]. The World Health Organization (WHO) established worldwide objectives for HC management, including a 90% decrease in new cases of chronic HC, a 65% reduction in HC-related deaths, and treatment of 80% of eligible patients with chronic HC infections [ 15 ].

Currently, no bibliometric analysis has evaluated research hotspots and deficiencies in the HC field. Herein, we conducted a study to reveal the scientific progress and prospects of HC research from 2013 to 2022 by using bibliometric methods, facilitating and presenting new inspiration for researchers to detect developing trends in the evolution of this field.

Materials and methods

Data collection and search strategy.

Data were retrieved from the Web of Science Core Collection (WoSCC) on a single day, June 6, 2022. WoSCC is a comprehensive database, particularly of natural science and medicine, which provides extensive citation index information for over 8,000 influential and famous journals worldwide. Several prior studies have used this database as a data source [ 16 , 17 ]. We included the following in the search strategy: title 0 - “hepatitis C”; database selected - Web of Science Core Collection; time span - 2013-2022. Only original articles and reviews were included. We obtained 17,773 records and screened the literature for the top 100 citations per year, which resulted in 1,000 records used in this study. A flowchart representing retrieval strategies is shown in Figure 1 .

A flowchart representing search strategies from the Web of Science Core Collection (WoSCC) database.

Analysis tool

Microsoft Excel 2016, VOSviewer, and CiteSpace were chosen for bibliometric analysis. Information about authors, journals, institutions, and countries can be integrated into these systems. Some parameters, such as article counts, the impact factor (IF), and occurrence/citation burst, were used in this study. Productivity was measured by the published article numbers and identified productive individuals or groups. The IF, a recognized metric for assessing the worldwide impact of a journal, was obtained using Journal Citation Reports (JCR) 2021.

The network visualization maps were constructed using VOSviewer to examine the cooperative relationships with highly co-cited references. Co-authorship analysis identifies research output. We selected “countries”, “organizations”, and “authors” as the unit of analysis. The parameters of the VOSviewer were set as follows: type of analysis - co-authorship; unit of analysis - countries; counting method - full counting; minimum documents of a country - 1; visualization method - Linlog/modularity. The same method was used to analyze “institutions” and “authors”. The only difference was we selected at least 5 and 3 minimum documents to analyze “institutions” and “authors”, respectively.

CiteSpace adopts a time-slicing technique to create a timeline of network models and integrates these individual networks to produce an overview network for the systematic analysis of the relevant publications. We used CiteSpace to perform a co-citation analysis of references and clusters. Further, a time zone visualization map of co-occurring keywords was built. As a result, we could clarify the origin and period of certain clustering fields [ 18 ]. A node’s centrality predicts its importance in a network, and a node with a high centrality is often viewed as a crucial point in a field [ 19 ]. These parameters help identify potential collaborative relationships in liver cirrhosis. Furthermore, the occurrence burst refers to a word that often emerges during a given period, whereas citation burst denotes a reference frequently referenced during a specific period [ 20 , 21 ]. Keywords with the highest citation bursts were chosen to illustrate research hotspots and frontiers because they indicate that relevant researchers have given substantial attention to these topics during a certain period [ 22 ]. The parameters of CiteSpace were set as follows: method - LLR; time slicing - 2013-2022; years per slice - 1.

Publication output

Figure 2A shows the distribution of yearly publications on the total 17,773 HC research articles from 2013 to 2022. The academic output was the most in 2017 (2,087 articles) but dropped afterward. We selected the top 1,000 articles based on citation numbers for further analysis. Figure 2B shows the number of articles published per country and the average number of citations per article. Table 1 lists the top 10 cited articles in descending order, and the citation number ranged from 794 to 1,636.

Trends of the annual worldwide publication output of hepatitis C research. A. The yearly trends of all articles retrieved. B. Distribution of top 1,000 articles by countries.

The top 10 cited articles in hepatitis C research field, 2013-2022

Distribution by country, institution, and authors

All of the 1,000 publications were from 78 countries. Table 2 shows detailed information on the top 10 countries. The USA had the most publications (519 publications), followed by France (131 publications) and Australia (127 publications). The USA has been the most remarkable in the past decade, indicating its overwhelming impact not only on HC research but also on medical science research, which may relate to the abundant resources and higher GDP [ 23 ].

The top 10 most productive countries among the top 1000 articles on hepatitis C research

We created a visualization map of HC research articles using VOSviewer to assess worldwide cooperation. Collaborations between countries, institutions, and authors are depicted in Figure 3 . Nodes with high co-occurrence are stained in the same color, and similar colors form one cluster, indicating closer partnerships. The different widths of the colored lines indicate the different scales of collaboration. The USA collaborated the most with other countries worldwide. Germany (69 collaborations) and England (67 collaborations) were the countries that collaborated the most with the USA.

Scientific influence of hepatitis C research worldwide. A. Influential countries. B. Influential institutions. C. Influential authors.

The clusters were led by Johns Hopkins University ( Figure 3B ). There existed no apparent differences between institutions in international cooperation. The most productive institutions are listed in Table 3 . The Johns Hopkins University (45 papers) ranked first, followed by Gilead Sciences Inc. (39 papers), the University of Pennsylvania, and the University of CA-San Francisco (34 papers). In addition, 7 of the top 10 institutions are located in the USA, indicating that the country has many strong research groups in this area.

The top 10 most productive institutions among the top 1000 articles on hepatitis C research

Table 4 lists the most productive author. With 40 articles, Dore GJ ranked first regarding publications, and Grebely J collaborated the most with him ( Figure 3C ). Grebely J (32 articles) was followed by Mchutchison JG (24 articles). Though Lawitz E ranked 6th with 22 articles, he had the highest citation/article ratio (270.82).

The top 10 most productive authors among the top 1000 articles on hepatitis C research

Distribution by journals

All papers included in the analysis were published in 270 professional academic journals. The number of papers published in the top 10 journals varied between 19 and 109, accounting for 43.2% ( Table 5 ). Among these journals, Hepatology contributed the highest number of publications (109 publications, IF 2021 = 17.298) and was the most frequently cited journal. The Journal of Hepatology (76 publications, IF 2021 = 30.083) was followed by Clinical Infectious Diseases (60 publications, IF 2021 = 20.999). The Lancet had the highest IF (202.731), and its citation/article ratio (253.89) was more than that of other listed journals.

The top 10 most productive journals among the top 1000 articles on hepatitis C research

Analysis of keywords

Based on the time zone, Figure 4 shows the HC research trend. The nodes move from left to right, showing the different topics that researchers tend to focus on in each period. Additionally, the size of each node reflects researchers’ interests in a given topic. In 2013, topics such as virus infection, sustained virologic response, therapy, ribavirin, hepatocellular carcinoma, and cirrhosis were more visible. In 2014, researchers focused more on epidemiology and genotype. Evidently, the research trend in 2015 shows that researchers have focused on direct-acting antiviral agents (DAA) such as sofosbuvir. In 2016, the studies on ledipasvir received considerable attention from researchers. The research in 2017 suggested that topics like therapy in people who inject drugs (PWID), velpatasvir, sofosbuvir plus ribavirin, safety, and efficacy, have received more attention than others. Treatment was still trending in 2018, with pibrentasvir and daclatasvir plus sofosbuvir receiving more attention. Meanwhile, HC and HIV co-infection has also been widely discussed. In 2019, virus, prevention, and HCC were more visible. In 2020, intervention and PWID remained widely discussed. In the last year of the Global health sector strategy on viral hepatitis 2016-2021, HCV clearance and HC elimination were paid increased attention. Presently, in 2022, more efforts are needed to access the goal of eliminating HC infections by 2030.

The time zone visualization map of co-occurring keywords in hepatitis C research.

Figure 5 shows the top 20 keywords with the strongest citation burst. The citation burst, which demonstrated a sharp rise in occurrence over a certain period, referred to frontier disciplines and dynamic changes in a particular field. Frontier topics were represented by keywords whose occurrence burst lasts until 2022. The most recent burst keywords were “care” (2018-2022), “virus” (2019-2022), “intervention” (2019-2022), “HCV” (2020-2022), “HIV” (2020-2022), and “risk” (2020-2022).

Keywords with the strongest citation burst on hepatitis C research.

Analysis of research areas and references

Table 6 presents the subject areas of study regarding HC. Over 37% of the studies were conducted in the Gastroenterology & Hepatology area. Furthermore, the research areas of General Internal Medicine (10%) & Immunology, Infectious Diseases, and Microbiology (7.8%) were also active. Researchers in these three areas published more than 50% of the studies and significantly influenced HC research development.

Active research areas in hepatitis C research

In bibliometric research, reference analysis is an important indication. The pieces of literature with the strongest citation burst are considered the knowledge fundamentals of the research frontiers [ 24 , 25 ]. The top 10 references with the strongest citation bursts are listed in Table 7 . The most recent burst references were “Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study” [ 26 ] and “EASL Recommendations on Treatment of Hepatitis C 2018” [ 27 ]. They both remained active till now (2019-2022).

Top 10 References with the Strongest Citation Bursts

Considering the top 1,000 cited papers concerning HC, the USA is undoubtedly the leading driving force, with most publications. Furthermore, 7 of the top 10 institutions are from the USA, showing its overwhelming strength. HCV is the most common bloodborne pathogen in the USA, chronically affecting approximately 2.4 million Americans [ 28 , 29 ]. However, most people often being asymptomatic for a long time and have not been tested for HCV, are unaware of the infection. Therefore, HCV eradication stands as a national goal. Although HC is no longer the leading cause of liver transplants in the USA [ 30 ], it remains the most dominant contributor to liver cancer mortality despite new antiviral therapies [ 31 ]. Contrarily, being the country with one of the most HCV-infected patients, China, the only developing country on the list, accounts for more than 14% of the worldwide HC prevalence [ 32 ]. In addition to the widespread lack of HC awareness, China has experienced a low rate of treatment uptake. Reportedly, about one-fifth of all yearly deaths from HC-related cirrhosis and HCC occur in China [ 33 ]. Therefore, to reduce the growing HC burden and achieve WHO’s targets by 2030 [ 15 ], China has conducted numerous studies to overcome the current challenges of eliminating HC. However, China still has a long way to go in terms of both quantity and quality.

Topics such as virus infection, sustained virologic response, therapy, ribavirin, hepatocellular carcinoma, and cirrhosis were more visible in 2013. This year, to inform public health decision-makers, Mohd Hanafiah K conducted a study that collected and analyzed prevalence data for estimating the HC burden [ 34 ]. This study has been cited widely and ranked 1st among the top 1,000 papers. The primary goal of treating HC is to achieve sustained virologic response (SVR); the development of DAA drugs has revolutionized the treatment of HC patients and has become the current standard. In 2013, a clinical trial published by Lawitz Eric et al. ranked 2nd among the top 10 articles [ 35 ]. This study tested the SVR rate of sofosbuvir for previously untreated HCV GT1, 4, 5, or 6 and found adverse events with sofosbuvir were less frequent than with peginterferon. In 2014, researchers focused more on epidemiology and genotype. Gower E et al. reported global epidemiology and genotype distribution of HCV [ 3 ]. Further, Polaris Observatory HCV Collaborators published a modeling study of the global prevalence and genotype distribution [ 26 ] as the most recent reference with the strongest citation bursts that have been widely cited and co-cited. Both papers have become a cornerstone of related research.

In 2015 and 2016, studies on DAA, such as sofosbuvir and ledipasvir, received considerable attention from researchers. Combination regimens of DAA agents targeting different viral proteins are often used to halt viral replication. A fixed-dose combination (FDC) tablet consisting of sofosbuvir, velpatasvir, and voxilaprevir was the first triple-DAA FDC approved in the US and EU [ 36 ]. Later research found that sofosbuvir/velpatasvir/voxilaprevir is an essential and practical option for treating HCV GT1-6 infection in adults, particularly those who have previously failed DAA treatment with or without an HCV NS5A inhibitor [ 36 ]. Several excellent open-label trials assessed the effectiveness of sofosbuvir and ledipasvir combination in treating HC in different conditions. Although limited data on the natural history of HCV GT5 infection is available, some evidence shows that patients with GT5 are usually older than those with other genotypes and often have high viral loads and cirrhosis [ 37 , 38 ]. A multicenter study showed that ledipasvir-sofosbuvir’s oral regimen is an effective and well-tolerated treatment both in treatment-naive or treatment-experienced patients with HCV GT5 infection [ 39 ]. The shortcoming of this trial was the small number of patients included. However, this all-oral ribavirin-free regimen may represent a significant advance in treating GT5 in HC, and is therefore, yet to be confirmed in more extensive trials. A randomized study found that ledipasvir-sofosbuvir combined with ribavirin had a higher SVR rate after 12 weeks of treatment in patients with advanced liver disease (including those with decompensated cirrhosis before and after liver transplantation) [ 40 ]. Thus, this became an effective and valuable treatment option for patients with GT1 or 4 and advanced liver disease.

Many DAAs are not recommended for use in patients with severe renal insufficiency because clearance of these drugs occurs primarily in the kidneys, limiting treatment options for severe renal impairment and HC. A study published in The Lancet Gastroenterology & Hepatology assessed sofosbuvir and ledipasvir to treat chronic GT1 HCV infection among severe kidney diseases [ 41 ] and was shown to be safe and effective in patients with stage 4-5 chronic kidney disease. Presently, the feasibility of DAAs therapy for liver transplant recipients is well-established; however, specific experience with new HC therapies after renal transplant is limited. More trials are necessary to evaluate the benefits of multiple new therapies in renal transplant patients and build more clinical decision-making experience.

Research topics such as therapy in people who inject drugs (PWID) attracted widespread attention in 2017. In 2018 the term treatment was still trending, and Pibrentasvir and daclatasvir plus sofosbuvir received more attention. A published recommendation on the HC treatment [ 27 ] gained extensive attention. As the reference with the strongest citation burst recently, exploring the knowledge base at the research forefront is potentially valuable. Meanwhile, HC and HIV co-infection has also been widely discussed. In 2019, the topic of prevention and HCC became more visible. Intervention and PWID remained extensively discussed in 2020. In the last year of the Global health sector strategy on viral hepatitis 2016-2021, HCV clearance and HC elimination were given greater attention. At present, in 2022, more efforts are needed to reach the goal of eliminating HC infections by 2030. More clinical randomized open-label trials should also be conducted to assess the virologic failure or post-treatment resistance of different regimens and their safety. Efficient, short-course, and simple DAA regimens can improve patient adherence and reduce the burden of medical and diagnostic procedures, thereby increasing the treatment accessibility. However, with the rapid availability of new regimens and the multiple factors to consider, the complexity of treatment selection has also increased. Future research on multiple regimens may further address the treatment needs of some difficult-to-treat subgroups or special populations and potentially streamline treatment recommendations.

To the best of our knowledge, this study is the first bibliometric analysis of HC research in the past decade; however, it has some limitations. First, the data was retrieved solely from the WoSCC database due to its reputable source of publications and citations, limiting all possible articles and the number of documents included in the analysis. Second, the search strategy might also be insufficient because we searched these articles only using “hepatitis C”, which may have led to a lack of articles due to other terminology. Additionally, we conducted a selected data analysis that may have ignored some specific essential points and details. As all the above reasons may lead to bias in the results, the interpretation of the results should be cautious.

This study provides a new inspiration for scientific research in the HC field. It showed that treatment was the most influential aspect of HC research, and more reports about clinical studies of new regimens may exist. Future research may focus more on HCV and HIV co-infection, treatment, and elimination of HC.

Disclosure of conflict of interest

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What Is Project 2025, and Why Is Trump Disavowing It?

The Biden campaign has attacked Donald J. Trump’s ties to the conservative policy plan that would amass power in the executive branch, though it is not his official platform.

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By Simon J. Levien

Donald J. Trump has gone to great lengths to distance himself from Project 2025, a set of conservative policy proposals for a future Republican administration that has outraged Democrats. He has claimed he knows nothing about it or the people involved in creating it.

Mr. Trump himself was not behind the project. But some of his allies were.

The document, its origins and the interplay between it and the Trump campaign have made for one of the most hotly debated questions of the 2024 race.

Here is what to know about Project 2025, and who is behind it.

What is Project 2025?

Project 2025 was spearheaded by the Heritage Foundation and like-minded conservative groups before Mr. Trump officially entered the 2024 race. The Heritage Foundation is a think tank that has shaped the personnel and policies of Republican administrations since the Reagan presidency.

The project was intended as a buffet of options for the Trump administration or any other Republican presidency. It’s the latest installment in the Heritage Foundation’s Mandate for Leadership series, which has compiled conservative policy proposals every few years since 1981. But no previous study has been as sweeping in its recommendations — or as widely discussed.

Kevin Roberts, the head of the Heritage Foundation, which began putting together the latest document in 2022, said he thought the American government would embrace a more conservative era, one that he hoped Republicans would usher in.

“We are in the process of the second American Revolution,” Mr. Roberts said on Real America’s Voice, a right-wing cable channel, in early July, adding pointedly that the revolt “will remain bloodless if the left allows it to be.”

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