M.D. Hepatitis C infection continues to be a major public health issue in the United States as we approach the year 2000. Razors and toothbrushes should not be shared and cuts or skin lesions should be covered. In stable monogamous relationships there is no firm recommendation that sexual practices be changed if the couple has been together for many years and no seroconversion in the mate has occurred.
Breast feeding appears to be safe as long as no open wounds are found around the areola.
Drug therapy for documented needle stick seroconverters for HCV RNA is still experimental at this time. Casual or social contact is not a risk factor. The gold standard for assessing disease activity and prognosis is the liver biopsy. There is no direct correlation between the ALT level and the severity of chronic hepatitis C. ALT levels should be used as a convenient, rough guide to monitoring these patients. Since the effects of hepatitis C appear to require years and even decades to be fully expressed in an individual, our focus should be on short term goals or normalization of ALT, eradication of HCV from serum, and improved histologic appearance on liver biopsy.