Hepatitis C
Blood-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
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
Chronic inflammation → cirrhosis → HCC; extrahepatic manifestations (cryoglobulinaemia).
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.