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Hepatite C

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  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Evidence last reviewed: 14 Feb 2026
Topic last updated: 15 Oct 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
Full details

Other diagnostic factors

  • sintomas constitucionais
  • icterícia
  • ascite
  • sinais de encefalopatia hepática
  • manifestações extra-hepáticas
Full details

Risk factors

  • práticas clínicas não seguras
  • uso de drogas por via intravenosa ou intranasal
  • transfusão de sangue ou transplante de órgão
  • consumo intenso de bebidas alcoólicas
  • polimorfismo no gene interleucina (IL) 28B
  • vírus da imunodeficiência humana (HIV)
  • prisão/institucionalização
  • diálise
  • trabalho na área da saúde
  • tatuagens/piercings corporais
  • acupuntura
  • vários parceiros sexuais
  • mãe infectada (para o feto)
  • sexo masculino
  • deficiência de vitamina D
Full details

Diagnostic tests

1st tests to order

  • ensaio imunoenzimático (EIE) para anticorpos contra o vírus da hepatite C (HCV)
  • reação em cadeia da polimerase para RNA de vírus da hepatite C (HCV)
  • aminotransferases séricas
Full details

Tests to consider

  • genotipagem viral
  • ensaio de antígeno de núcleo do vírus da hepatite C (HCV)
  • testes não invasivos de fibrose hepática ou elasticidade
  • índice da relação aspartato aminotransferase sobre plaquetas (APRI)
  • biópsia hepática
  • testes para coinfecção
Full details

Treatment algorithm

INITIAL

infecção recente

ACUTE

infecção crônica adequada para tratamento simplificado: qualquer genótipo

infecção crônica não adequada para tratamento simplificado ou pacientes virgens de tratamento: genótipo 1a

infecção crônica não adequada para tratamento simplificado ou pacientes virgens de tratamento: genótipo 1b

infecção crônica não adequada para tratamento simplificado ou pacientes virgens de tratamento: genótipo 2

infecção crônica não adequada para tratamento simplificado ou pacientes virgens de tratamento: genótipo 3

infecção crônica não adequada para tratamento simplificado ou pacientes virgens de tratamento: genótipo 4

infecção crônica não adequada para tratamento simplificado ou pacientes virgens de tratamento: genótipo 5 ou 6

infecção crônica não adequada para tratamento simplificado ou pacientes com tratamento prévio: todos os genótipos

ONGOING

cirrose descompensada

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

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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