HCV in the USA

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What percent of persons with chronic HCV infection will develop lethal liver cancer?
1% to 5%
15% to 25%
60% to 70%
75% to 85%

The virus

Hepatitis C is a ribonucleic acid (RNA) virus in the Flaviviridae family. RNA based viruses, like HCV, store their genetic code within ribonucleic acid, rather than DNA. HCV's RNA is protected within a lipid coat that allows it to fuse to the host cell's outer membrane and merge with it. The virus's lipid coat essentially becomes part of the host cell membrane, depositing the virus RNA inside. Once inside, the virus takes over the host cell and begins to create viral components. The newly created viral components attach to the inside of the host membrane. When the components attach, they deform the membrane causing it to bulge out, creating a bud. The bud pinches off from the host and a new virus is released. This process continues over and over again until the cell is exhausted and dies. Once outside the host cell, the new virus contacts a new host and begins replication, each time creating many, many new viruses.

RNA viruses, like HCV, HIV and Influenza A, are notorious for their ability to mutate and confound vaccines and treatments. HCV's RNA amino acids differs from DNA by only one base. It is composed of adenine, guanine, cytosine and uracil, rather than thymine. It is also a single strand rather than a double. Being a single strand means that it's elements don't have to match up with a complimentary base on an opposing strand, as does DNA. One base can often be substituted for another without inactivating the virus. A substitution usually results in a protein of a slightly different shape. It is the change in shape that confounds vaccines and drugs by moving the position of binding sites.

Researchers have found that half of the virus's mutations are in sites that our immune system attacks. As the virus mutates, it changes the location of the binding site that our immune system can recognize. It can then change back to the “ancestral” set of amino acids. That is, when the virus is under attack, it changes, and then when it's safe, it changes back. Thus, if the virus moves from one host to another, it may lose the mutations that it needed to escape the immune system of the first host, if they aren't needed in the second host. Researchers have found that the mutations are not random, as had been earlier assumed, and the viruses in different people infected by the same ancestral virus have similar genetic elements and mutations. This new information could make it easier to target a vaccine in the future.

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HCV gets inside of the host cell and replicates, creating thousands of copies of itself.


Hepatitis C contains a range of viruses that are similar enough to be classified as HCV, but different enough to be classified as subgroups. There are main types of Hepatitis C that are called genotypes, and there are subtypes of those. Some viral differences are not significant enough to form another sub-type, and these are known as quasi-species. It is believed that within an HCV sub-type, there may be several million quasi-species. All this variation affects response to treatment and progression of the disease. Some researchers classify all HCV into 6 genotypes and others into 11. HCV is classified according to the genotype (1 to 11) as well as the subtype (1a, for example):

Geographic distribution
North & South America, Australia (most common in US)
Europe & Asia
Japan & China
US and Northern Europe
Western & Southern Europe
Australia & South Asia
Central Africa
South Africa
Hong Kong, Macau, & Vietnam
7a, 7b
8a, 8b, 9a
10a & 11a

The distribution of genotypes in the United States involves primarily the genotypes 1, 2, and 3:

Percentage of total HCV cases in US
1a & 1b
1 & 2

Instant Feedback:
The most common HCV in the USA is genotype 2.


Edlin BR, Eckhardt BJ, Shu MA, Holmberg SD, Swan T. (2015). Toward a more accurate estimate of the prevalence of hepatitis C in the United States. Hepatology. 62(5):1353-63.

U.S. Dept. of Health and Human Sevices, Center for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention, Division of Viral Hepatitis. Guide to Comprehensive Hepatitis C Counseling and Testing.