Hepatitis C
Chapter notes (PDF)PDFBlood-borne RNA virus causing acute and chronic hepatitis; most cases are asymptomatic until advanced liver disease. Direct-acting antiviral (DAA) regimens achieve >95% cure rates in the UK when adherence and regimen selection are correct.
Key Facts
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Key points
- Anti-HCV screening in risk cohorts; HCV RNA confirms viraemia.
- Pangenotypic DAA regimens (examples): sofosbuvir/velpatasvir one tablet OD for 12 weeks in treatment-naïve without cirrhosis (duration varies by cirrhosis/retreatment - specialist).
- Glecaprevir/pibrentasvir three tablets OD with food for 8–16 weeks depending on scenario.
- Ribavirin sometimes added in decompensated disease - specialist.
- Drug interactions via CYP/P-gp - check HCV DAA interaction checker before prescribing.
Overview
Epidemiology
People who inject drugs, recipients of blood products before 1991 in UK, HIV MSM cohorts.
Natural history
Clinical Presentation
Acute
Often mild; may present as ALT flare.
Chronic
Fatigue; stigmata of chronic liver disease if cirrhosis.
Differential Diagnosis
| Alternative | Clue |
|---|---|
| HBV | HBsAg positive |
| Alcohol-related liver disease | History, AST:ALT pattern |
| NAFLD | Metabolic risk, imaging |
Diagnosis / Investigation
Virology
HCV RNA, genotype less critical with pangenotypic regimens but still used in some pathways.
Staging
Transient elastography (FibroScan), blood fibrosis scores.
HIV/HBV
Co-test before DAA.
Management
Treatment (examples - specialist-led)
- Sofosbuvir/velpatasvir 400/100 mg OD for 12 weeks (common first line).
- Decompensated cirrhosis: refer transplant centre; DAA regimens individualised.
Harm reduction
Needle exchange, opioid substitution, alcohol advice.
Prognosis
Sustained virological response (undetectable RNA 12 weeks post-therapy) equals cure in most; continue HCC surveillance if cirrhosis established.
Other Relevant Information
Reinfection
Risk persists with ongoing risk behaviours - counsel and test.