Last reviewed: 24 Dec 2021
Last updated: 23 Mar 2021



History and exam

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/institutionalisation
  • haemodialysis
  • healthcare work
  • tattoos
  • multiple sex partners
  • infected mother (for fetus)
  • male sex

Diagnostic investigations

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

Treatment algorithm



Jawad Ahmad, MD, FRCP, FAASLD

Professor of Medicine

Division of Liver Diseases

Mount Sinai Hospital

New York



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 topic.


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



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



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




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



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

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