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Hepatitis C

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Última revisão das evidências: 14 Feb 2026
Última atualização do tópico: 15 Oct 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • presencia de factores de riesgo
Detalhes completos

Outros fatores diagnósticos

  • síntomas constitucionales
  • ictericia
  • ascitis
  • signos de encefalopatía hepática
  • manifestaciones extrahepáticas
Detalhes completos

Fatores de risco

  • prácticas médicas inseguras
  • consumo de drogas ilícitas por vía intravenosa o intranasal
  • transfusión de sangre o trasplante de órganos
  • consumo excesivo de alcohol
  • polimorfismo del gen de interleucina (IL)-28B
  • VIH
  • encarcelamiento/institucionalización
  • diálisis
  • profesión relacionada con la salud
  • tatuajes/perforaciones corporales
  • acupuntura
  • parejas sexuales múltiples
  • madre infectada (para el feto)
  • sexo masculino
  • deficiencia de vitamina D
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • Inmunoanálisis de enzimas de anticuerpos del virus de la hepatitis C (VHC)
  • reacción en cadena de la polimerasa (PCR) para el ARN del virus de la hepatitis C (VHC)
  • aminotransferasas séricas
Detalhes completos

Investigações a serem consideradas

  • genotipado viral
  • ensayo del antígeno central del virus de la hepatitis C (VHC)
  • pruebas no invasivas de fibrosis hepática o elasticidad
  • índice de relación aspartato aminotransferasa/plaquetas (APRI)
  • biopsia hepática
  • pruebas para detectar una coinfección
Detalhes completos

Algoritmo de tratamento

Inicial

infección reciente

AGUDA

infección crónica apta para un tratamiento simplificado: cualquier genotipo

infección crónica no apta para tratamiento simplificado y sin tratamiento: genotipo 1a

infección crónica no apta para tratamiento simplificado y sin tratamiento: genotipo 1b

infección crónica no apta para tratamiento simplificado y sin tratamiento: genotipo 2

infección crónica no apta para tratamiento simplificado y sin tratamiento: genotipo 3

infección crónica no apta para tratamiento simplificado y sin tratamiento: genotipo 4

infección crónica no apta para tratamiento simplificado y sin tratamiento: genotipo 5 o 6

infección crónica no apta para el tratamiento simplificado y con experiencia en el tratamiento: todos los genotipos

CONTÍNUA

cirrosis descompensada

Colaboradores

Autores

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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