Chronic Hepatitis C (HCV)
Hepatitis C virus primarily spreads through blood-to-blood contact. About 75–85% of acute infections progress to chronic infection, which can lead to cirrhosis, hepatocellular carcinoma, and extrahepatic complications. Fortunately, direct-acting antivirals (DAAs) cure >95% of cases.
Transmission & Risk Factors
- Sharing needles or injection equipment
- Blood transfusions or organ transplants before 1992 (pre-screening)
- Hemodialysis, occupational needle sticks
- Non-sterile tattoos or piercings
- Sexual transmission (higher risk for MSM with HIV)
- Perinatal transmission (5–6%)
Symptoms
Most chronic HCV cases remain asymptomatic for years. Possible signs:
- Fatigue, mild RUQ discomfort
- Joint pain, muscle aches
- Pruritus, dark urine, jaundice (advanced disease)
- Easy bruising, abdominal swelling when cirrhosis develops
Screening & Diagnosis
- Universal one-time screening for adults aged 18–79, plus risk-based testing.
- Antibody test followed by HCV RNA PCR to confirm active infection.
- Genotype testing (less essential since pan-genotypic regimens exist).
- Baseline labs: CBC, CMP, INR, HBV/HIV screening, pregnancy test if applicable.
- Fibrosis staging: FibroScan, FIB-4, APRI, or biopsy.
Treatment
- Goal: sustained virologic response (SVR) = cure (undetectable HCV RNA 12 weeks post-therapy).
- Pan-genotypic DAAs:
- Sofosbuvir/velpatasvir (Epclusa) – 12 weeks for most patients.
- Glecaprevir/pibrentasvir (Mavyret) – 8 weeks for uncomplicated cases.
- Adjust regimens for cirrhosis, prior treatment failures, renal impairment, or drug interactions.
- Monitor labs during therapy; counsel on adherence.
Post-Cure Care
- Assess for fibrosis regression and manage comorbidities.
- Continue HCC surveillance if advanced fibrosis/cirrhosis (every 6 months).
- Avoid reinfection: safe injection practices, condoms, do not share personal items.
Extrahepatic Manifestations
- Mixed cryoglobulinemia (vasculitis)
- Renal disease (membranous nephropathy)
- Insulin resistance, type 2 diabetes
- Lymphomas, Sjögren-like syndrome, rheumatoid-like arthropathy
Lifestyle & Prevention
- Vaccinate against HBV and HAV if not immune.
- Maintain healthy weight to reduce fatty liver.
- Limit alcohol and hepatotoxic medications.
- Engage in regular exercise and balanced diet.
Research & Future Directions
Efforts focus on vaccines, shorter DAA courses, and broader access in low-resource settings.
Experimental & Emerging Treatments
- Long-Acting Injectable DAAs: Depot formulations aim for single-dose cures to improve adherence in high-risk populations.
- HCV Vaccines: Multiple T-cell and antibody-based vaccines are in trials to prevent reinfection.
- Host-Targeted Therapies: Entry inhibitors and lipid-modulating drugs seek to block viral replication without resistance.
- CRISPR-Based Approaches: Experimental gene-editing aims to excise integrated viral fragments in hepatocytes.
Track HCV with Diagnoza.care
Stay Cured and Informed – Log HCV RNA results, liver labs, imaging, medications, side effects, and lifestyle habits, schedule hepatology visits, and let the AI companion surface reminders for fibrosis and HCC screening.
Medical Disclaimer: Informational only. Follow your hepatologist or infectious disease specialist for diagnostic testing, antiviral therapy, and post-cure monitoring.
Sources: Centers for Disease Control and Prevention, American Association for the Study of Liver Diseases, World Health Organization