Summary
Definition
History and exam
Key diagnostic factors
- unsafe medical practices
- intravenous or intranasal drug use
- history of transfusion or organ transplantation
Other diagnostic factors
- constitutional symptoms
- jaundice
- ascites
- signs of hepatic encephalopathy
- extrahepatic manifestations
Risk factors
- 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
Diagnostic tests
1st tests to order
- hepatitis C virus (HCV)-antibody enzyme immunoassay (EIA)
- hepatitis C virus (HCV) RNA polymerase chain reaction (PCR)
- serum aminotransferases
Tests to consider
- 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
Treatment algorithm
recent infection
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
decompensated cirrhosis
Contributors
Authors
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
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.
Differentials
- Hepatitis B
- Hepatitis D
- Hepatitis E
More DifferentialsGuidelines
- Clinical screening and diagnosis for hepatitis C
- Guidelines for health care personnel exposed to hepatitis C virus
More GuidelinesPatient information
Hepatitis C: what is it?
Hepatitis C: what are the treatment options?
More Patient information
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