Hepatitis C Virus Infection
A curable viral liver disease transmitted via blood that causes silent liver damage, cirrhosis, and cancer over decades.
Emergency Management: Hepatic encephalopathy. Treat with Lactulose 30 mL PO q1-2h until bowel movement.
Hepatitis C is a blood-borne viral infection caused by the Hepatitis C virus (HCV), a positive-sense single-stranded RNA virus. It causes chronic liver inflammation in 75-85% of acutely infected patients, leading to progressive fibrosis and cirrhosis.
Detailed Overview
HCV is highly insidious, often remaining asymptomatic for decades. Unlike HBV, it is highly curable with short courses of direct-acting antivirals (DAAs) that target viral proteins (NS3/4A, NS5A, NS5B). Widespread screening is essential to identify infected individuals before irreversible liver damage or hepatocellular carcinoma (HCC) occurs.
Epidemiology & Demographics
About 58 million people globally have chronic HCV. Incidence in the US is highest among baby boomers (1945-1965) and younger adults via injection drug use.
Etiological Mechanism
Hepatitis C virus (Genotypes 1-6).
Primary Causes
Hepatitis C virus (HCV)
HCV enters hepatocytes and translates its RNA into a polyprotein, cleaved by viral proteases into structural and non-structural proteins (e.g., NS5A). The virus replicates in the cytoplasm. The host immune system attempts to clear infected cells via CD8+ T-cells, but HCV's high mutation rate leads to immune evasion. Chronic inflammation drives hepatic stellate cell activation and collagen deposition.
Diagnostic Criteria & Guidelines
Positive HCV antibody followed by detectable quantitative HCV RNA PCR.
Glecaprevir/Pibrentasvir 300/120 mg PO daily for 8 weeks OR Sofosbuvir/Velpatasvir 400/100 mg PO daily for 12 weeks.
Second-Line & Adjunctive Therapy
Sofosbuvir/Velpatasvir/Voxilaprevir 400/100/100 mg PO daily for 12 weeks (for DAA failures).
Surgical & Procedural Management
Liver transplantation for end-stage liver disease (MELD > 15).
Patient Counseling & Advice
DAAs have >95% cure rates but do not grant immunity; reinfection is possible. Assess for drug interactions (e.g., PPIs, statins).
Follow-Up & Monitoring Schedule
Check HCV RNA 12 weeks post-treatment to confirm Sustained Virologic Response (SVR12). If cirrhosis present, life-long ultrasound every 6 months for HCC.
Preventive Strategies
Harm reduction programs (needle exchange). No vaccine available.
>95% cure rate with DAAs, drastically reducing mortality.