Hepatitis C

Overview

Hepatitis C is a viral infection caused by the hepatitis C virus (HCV) that primarily affects the liver and is transmitted through blood and, less commonly, through body fluids or vertical transmission. It poses a significant global health burden due to its high rate of chronicity and long-term complications, including cirrhosis and hepatocellular carcinoma. With the advent of direct-acting antivirals (DAAs), hepatitis C has become a highly treatable condition, though no vaccine currently exists.

Definition

Hepatitis C is a blood-borne viral infection of the liver caused by HCV, often progressing to chronic disease, liver fibrosis, cirrhosis, and hepatocellular carcinoma if untreated.

Aetiology

  • Hepatitis C virus (HCV) – a positive-sense single-stranded RNA virus
  • Genetically diverse with multiple genotypes

Transmission

  • Blood-borne transmission – e.g. intravenous drug use (IVDU), needle sharing (as little as 0.0001 mL of blood)
  • Body fluids – e.g. semen, cervical secretions (less common)
  • Vertical transmission – rare, but possible during childbirth
  • No vaccine is available, making prevention more difficult

Morphology / Pathophysiology

  • Virus replicates in hepatocytes
  • Not directly cytopathic – Liver damage results from CD8+ T-cell-mediated immune attack
  • Chronic inflammation → periportal fibrosis → cirrhosis over time
  • Common findings:
    • Periportal inflammatory infiltrates
    • Apoptosis, necrosis
    • Microvesicular steatosis (fatty change)
    • Progressive fibrosis and nodular regeneration → cirrhosis

Clinical Features

Acute Hepatitis C

  • Occurs in ~10% of cases
  • Mild viral illness with:
    • Nausea, anorexia, fatigue
    • Jaundice (sometimes)
    • May recover fully

Chronic Hepatitis C

  • Occurs in ~90% of cases
  • Often asymptomatic for years (incidental diagnosis)
  • May present with:
    • Mild, intermittent viral symptoms
    • Arthralgia or arthritis
    • Glomerulonephritis
    • Progressive liver damage → cirrhosis in 20–30% within 10–30 years
    • 5% develop hepatocellular carcinoma due to HCV-induced p53 inactivation
HEPATITIS C
HEPATITIS C

Investigations

  • Liver function tests (LFTs) – mildly elevated ALT/AST
  • Anti-HCV serology – positive in both acute and chronic phases
  • HCV RNA PCR – confirms active infection
  • Staging via liver biopsy, elastography (e.g. FibroScan) or imaging for cirrhosis

Management

Acute or Post-Exposure (e.g. needlestick):

  • Historically managed with interferon (IFN) and ribavirin
  • Rarely used now due to better treatments

Chronic Infection:

  • Direct-Acting Antivirals (DAAs) – cure rates >95%
    • Epclusa® (sofosbuvir + velpatasvir)
    • Harvoni® (sofosbuvir + ledipasvir)
    • Maviret® (glecaprevir + pibrentasvir)
  • Treatment is usually oral, short-duration (8–12 weeks), well-tolerated

Complications

  • Cirrhosis – fibrotic scarring of the liver
  • Hepatocellular carcinoma (HCC) – especially with cirrhosis
  • Renal disease, cryoglobulinemia, autoimmune manifestations

Summary

Hepatitis C is a chronic viral infection transmitted primarily via blood, often progressing silently to cirrhosis or hepatocellular carcinoma. While no vaccine exists, modern direct-acting antiviral treatments offer high cure rates. For broader context and related conditions, see our Reproductive Health Overview page.

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