Hepatitis C

Last reviewed: 6 Sep 2022
Last updated: 28 Jul 2022

Summary

Definition

History and exam

Key diagnostic factors

  • unsafe medical practices
  • intravenous or intranasal drug use
  • history of transfusion or organ transplantation
More key diagnostic factors

Other diagnostic factors

  • constitutional symptoms
  • jaundice
  • ascites
  • signs of hepatic encephalopathy
  • extrahepatic manifestations
Other diagnostic factors

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
  • hemodialysis
  • healthcare work
  • tattoos/body piercing
  • multiple sex partners
  • infected mother (for fetus)
  • male sex
  • vitamin D deficiency
More risk factors

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
More 1st investigations to order

Investigations to consider

  • viral genotyping
  • noninvasive tests of liver fibrosis or elasticity
  • liver biopsy
  • testing for co-infection
More investigations to consider

Emerging tests

  • HCV antigen

Treatment algorithm

INITIAL

recent infection

ACUTE

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

ONGOING

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.

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