The American Association for the Study of Liver Diseases (AASLD)/Infectious Diseases Society of America (IDSA) have updated their hepatitis C guidelines to reflect several important developments, including the approval of glecaprevir/pibrentasvir and sofosbuvir/velpatasvir/voxilaprevir for the treatment of all genotypes of hepatitis C virus.See Management: approach
Transmission is through percutaneous exposure to infected blood, most commonly through injection of illicit drugs or transfusion of contaminated blood products in developed countries, or via contaminated medical or dental equipment in resource-poor countries.
Following acute exposure to hepatitis C virus, about 55% to 85% of patients develop chronic hepatitis C. Most infections are asymptomatic; however, hepatic inflammation is often present and can lead to progressive hepatic fibrosis.
The goal of treatment is to eradicate the virus, achieve a sustained virologic response, and prevent disease progression. Oral direct-acting antiviral therapies are standard treatment; therapy is evolving at a rapid pace.
Long-term complications of chronic infection include cirrhosis or hepatocellular carcinoma.
Hepatitis C virus (HCV) is an infectious, hepatotropic virus belonging to the Flavivirus family.  Infection may present as an acute illness (e.g., fatigue, arthralgia, jaundice) in approximately one third of patients; however, the majority of patients are asymptomatic. Chronic infection causes liver inflammation and fibrosis, and a significant number of these patients will develop cirrhosis and liver failure or liver cancer over a period of approximately 20 to 50 years. The infection rarely resolves spontaneously in patients with chronic infection.
Professor of Medicine
Division of Liver Diseases
Mount Sinai Hospital
JA declares that he has no competing interests.
Dr Jawad Ahmad would like to gratefully acknowledge Dr Brian L. Pearlman, the previous contributor to this monograph. BLP is on the speakers’ bureaus and serves as an advisor to Merck, Gilead, J&J, and AbbVie, and does contracted research with Boehringer Ingelheim, Tibotec/Janssen, Bristol-Myers Squibb, Gilead, and Merck. BLP is also an author of a number of references cited in this monograph. BLP wishes to acknowledge Chaithanya Mallikarjun, MD, for her help in writing the original version of the manuscript.
Digestive Disease and Liver Transplant
AL has participated in an advisory board meeting with Gilead and Janssen, and is a primary investigator for Merck’s C-Surfer trial.
Director of Hepatology and Medical Director of Liver Transplantation
Associate Professor of Medicine
Strong Memorial Hospital
University of Rochester
BM belongs to the paid speaker’s bureau for pharmaceutical companies Gilead (maker of ledipasvir/sofosbuvir), AbbVie (maker of Viekira Pak® - ombitasvir/paritaprevir/ritonavir and dasabuvir), Merck, and Salix.
Bradford Teaching Hospitals Foundation Trust
SM has received sponsorship and has sat on advisory boards for BMS, Gilead, AbbVie, and Merck.
Nottingham University Hospitals NHS Trust
SR is an advisory board (paid) member for AbbVie, Gilead, Janssen, and MSD.
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