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Hepatitis C

  • Обзор
  • Теория
  • Диагноз
  • Лечение
  • Последующее наблюдение
  • Источники
Последний просмотренный: 23 Sep 2025
Last updated: 15 Oct 2025

Резюме

Определение

Анамнез и осмотр

Ключевые диагностические факторы

  • unsafe medical practices
  • intravenous or intranasal drug use
  • history of transfusion or organ transplantation
Полная информация

Другие диагностические факторы

  • constitutional symptoms
  • jaundice
  • ascites
  • signs of hepatic encephalopathy
  • extrahepatic manifestations
Полная информация

Факторы риска

  • unsafe medical practices
  • intravenous or intranasal drug use
  • blood transfusion or organ transplant
  • heavy alcohol use
  • interleukin (IL)-28B gene polymorphism
  • HIV
  • incarceration/institutionalization
  • dialysis
  • healthcare work
  • tattoos/body piercing
  • acupuncture
  • multiple sex partners
  • infected mother (for fetus)
  • male sex
  • vitamin D deficiency
Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

  • hepatitis C virus (HCV)-antibody enzyme immunoassay (EIA)
  • hepatitis C virus (HCV) RNA polymerase chain reaction (PCR)
  • serum aminotransferases
Полная информация

Исследования, проведение которых нужно рассмотреть

  • viral genotyping
  • hepatitis C virus (HCV) core antigen assay
  • noninvasive tests of liver fibrosis or elasticity
  • aspartate aminotransferase-to-platelet ratio index (APRI)
  • liver biopsy
  • testing for co-infection
Полная информация

Алгоритм лечения

Начальные

recent infection

Острый

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

ПРОДОЛЖЕНИЕ

decompensated cirrhosis

Составители

Авторы

Jawad Ahmad, MD, FRCP, FAASLD

Professor of Medicine

Division of Liver Diseases

Mount Sinai Hospital

New York

NY

Disclosures

JA declares that he has no competing interests.

Acknowledgements

Dr Jawad Ahmad would like to gratefully acknowledge Dr Brian L. Pearlman, the previous contributor to this topic.

Disclosures

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 topic. BLP wishes to acknowledge Chaithanya Mallikarjun, MD, for her help in writing the original version of the manuscript.

Peer reviewers

AnnMarie Liapakis, MD

Assistant Professor

Digestive Disease and Liver Transplant

Yale University

CT

Disclosures

AL has participated in an advisory board meeting with Gilead and Janssen, and is a primary investigator for Merck’s C-Surfer trial.

Benedict Maliakkal, MRCP

Director of Hepatology and Medical Director of Liver Transplantation

Associate Professor of Medicine

Strong Memorial Hospital

University of Rochester

NY

Disclosures

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.

Sulleman Moreea, FRCS (Glasg), FRCP

Consultant Hepatologist

Bradford Teaching Hospitals Foundation Trust

Bradford

UK

Disclosures

SM has received sponsorship and has sat on advisory boards for BMS, Gilead, AbbVie, and Merck.

Steve Ryder, DM, FRCP

Consultant Hepatologist

Nottingham University Hospitals NHS Trust

UK

Disclosures

SR is an advisory board (paid) member for AbbVie, Gilead, Janssen, and MSD.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

American Association for the Study of Liver Diseases; Infectious Diseases Society of America. HCV guidance: recommendations for testing, managing, and treating hepatitis C. Dec 2023 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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