Hepatitis C: A Bitter Harvest

We know a lot about chronic infection with hepatitis C virus (HCV): It affects 170 million people worldwide, accounts for approximately 40% of all cases of chronic liver disease, can be associated with hepatic decompensation and hepatocellular carcinoma, and is the most common indication for liver transplantation (1). Although we have learned so much about this disease during the past 3 decades, we continue to be surprised by new insights and revelations.

In this issue, 2 articles on HCV infection reinforce the far-reaching nature of this disease. In a thought-provoking article, McGuire and colleagues (2) describe the frequent occurrence of glomerulonephritis in patients with HCV-associated cirrhosis who undergo liver transplantation. Although we tend to attribute renal compromise in such patients to tubular injury, this report adds to evidence (3, 4) that glomerular lesions are unappreciated, suggesting that we should evaluate renal injury more thoroughly before and after liver transplantation.

In the other article, Armstrong and colleagues at the Centers for Disease Control and Prevention (5) focus attention on another inadequately recognized dimension of HCV infection by presenting an updated analysis of the prevalence and acquisition of HCV. This article, which is based on data collected between 1999 and 2002 as part of the National Health and Nutrition Examination Survey (NHANES), provides a valuable perspective on how human behaviors have contributed to the scourge that hepatitis C has become.

A previous NHANES analysis conducted between 1988 and 1994 (6) showed that 1.8% of the U.S. population—approximately 4 million persons—had serum antibodies to HCV (anti-HCV), serologic evidence of past or current infection. Approximately 3 million persons had detectable levels of …