Hepatitis C virus transmission is through percutaneous exposure to infected blood, most commonly through injection of illicit drugs or transfusion of unscreened blood and blood products in developed countries, or via unsafe injection practices in resource-poor countries.
Following acute exposure to hepatitis C virus, many 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 virological response, and prevent disease progression. Oral direct-acting antiviral therapies are standard treatment.
Long-term complications of chronic infection include cirrhosis or hepatocellular carcinoma.
Hepatitis C is an inflammation of the liver caused by the hepatitis C virus (HCV). 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. Patients with acute infection may spontaneously clear the virus. 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.
History and exam
Key diagnostic factors
- presence of risk factors
Other diagnostic factors
- constitutional symptoms
- signs of hepatic encephalopathy
- extrahepatic manifestations
- unsafe medical practices
- intravenous or intranasal drug use
- blood transfusion or organ transplant
- heavy alcohol use
- interleukin (IL)-28B gene polymorphism
- healthcare work
- tattoos/body piercing
- multiple sex partners
- infected mother (for fetus)
- male sex
- vitamin D deficiency
1st investigations to order
- hepatitis C virus (HCV)-antibody enzyme immunoassay (EIA)
- hepatitis C virus (HCV) RNA polymerase chain reaction (PCR)
- serum aminotransferases
Investigations to consider
- viral genotyping
- non-invasive tests of liver fibrosis or elasticity
- liver biopsy
- testing for co-infection
- HCV antigen
chronic infection suitable for simplified treatment: any genotype
chronic infection not suitable for simplified treatment and treatment-naive: genotype 1a
chronic infection not suitable for simplified treatment and treatment-naive: genotype 1b
chronic infection not suitable for simplified treatment and treatment-naive: genotype 2
chronic infection not suitable for simplified treatment and treatment-naive: genotype 3
chronic infection not suitable for simplified treatment and treatment-naive: genotype 4
chronic infection not suitable for simplified treatment and treatment-naive: genotype 5 or 6
chronic infection not suitable for simplified treatment and treatment-experienced: all genotypes
- Chronic hepatitis B
- Alcoholic liver disease
- HCV guidance: recommendations for testing, managing, and treating hepatitis C
- Sexually transmitted infections treatment guidelines, 2021
Hepatitis C: what is it?
Hepatitis C: what treatments work?More Patient leaflets
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