Overview
The hepatitis C (HCV) virus is an RNA virus spread through exposure to infected blood or bodily fluids, and through vertical transmission from mother to child. It may lead to a self-limiting disease but can result in chronic hepatitis C which can predispose to liver cirrhosis and hepatocellular cancer.
The incubation period of HCV is around 6-9 weeks. There is no vaccine for hepatitis C.
Epidemiology
- Hepatitis C may be undiagnosed as it can remain asymptomatic for many years after infection
- Hepatitis C is found worldwide but its prevalence is not evenly distributed
Risk Factors
- Close contact with people infected with HCV
- Injecting intravenous drugs
- High-risk sexual behaviours (e.g. unprotected sex with multiple partners)
- Family history
- Infants born to mothers with HCV
Presentation
Many patients are asymptomatic until liver cirrhosis, failure, or hepatocellular carcinoma develops. Features seen may include:
- Flu-like prodrome: fever, chills, malaise, joint pain
- Nausea and vomiting
- Right upper quadrant pain
- Jaundice
- Tender hepatomegaly
- Palmar erythema
- Spider naevi
- Ascites
- Asterixis
Differential Diagnoses
Acute hepatitis A
- Although there is no significant difference in presentation, hepatitis A is transmitted via the faecal-oral route. An example risk factor can be eating and drinking in unhygienic places
Acute hepatitis E
- Although there is no significant difference in presentation, hepatitis E is transmitted via the faecal-oral route. An example risk factor can be eating and drinking in unhygienic places
- Hepatitis E classically affects pregnant people
Investigations
- Liver function tests:
- In acute hepatitis C:
- Bilirubin – increased (usually >85 µmol/L)
- ALT, AST – increased (usually 500 – 10,000 IU/L) and ALT > AST
- ALP – may be raised to up to 2 times the upper limit of normal
- In chronic hepatitis C, AST and/or ALT may be slightly elevated or normal
- In acute hepatitis C:
- Hepatitis C RNA testing:
- If positive, send a repeat test for confirmation of infection
- If negative, send a repeat test after 6 months. If still negative, then the person has cleared the infection but is not immune to reinfection.
Management
Overview
- 1st-line: refer to gastroenterology/hepatology and notify Public Health England
- Antivirals are given depending on the HCV genotype which is tested before treatment.
Monitoring
- Patients are followed up by specialists and regularly have liver function tests and HCV RNA testing to assess their response to treatment.
Patient Advice
- Patients should avoid drinking alcohol as this can increase the risk of cirrhosis and hepatocellular carcinoma
- Patients should take steps to minimise transmission to other people:
- Avoid sharing items that may be contaminated with blood (e.g. toothbrushes and razors)
- Avoid unprotected sexual intercourse including oro-anal or oro-genital sex until they have become non-infectious or their partner has been immunised
- Avoid sharing needles
- Avoid donating blood, semen, or organs
Complications
- Acute hepatitis C can lead to fulminant hepatitis (<1%)
- Chronic hepatitis can develop in around 50-85% of patients
Prognosis
- The prognosis varies significantly and depends on the severity of liver fibrosis