Hepatitis C

Key points

• Hepatitis C is likely to become a significant public health problem in the UK in the next decade. It is thought around 200,000 people are chronically infected with the virus.
• hepatitis C is a RNA flavivirus
• incubation period: 6-9 weeks Transmission
• the risk of transmission during a needle stick injury is about 2%
• the vertical transmission rate from mother to child is about 6%. The risk is higher if there is coexistent HIV
• DIAGNOSIS: HCV ANTIBODY is the screening test but only indicates exposure — it stays positive after clearance. ACTIVE infection must be confirmed with HCV RNA (or HCV core antigen). Around 15–45% of those infected clear the virus spontaneously; the rest develop chronic infection.
• TREATMENT IS NOW CURATIVE, ORAL AND INTERFERON-FREE. Modern DIRECT-ACTING ANTIVIRALS (DAAs) — pan-genotypic regimens such as sofosbuvir/velpatasvir or glecaprevir/pibrentasvir — are given for 8–12 WEEKS and cure MORE THAN 95% of people who complete treatment. Sofosbuvir/velpatasvir/voxilaprevir is used for retreatment after failure.
• CURE is defined as SUSTAINED VIROLOGICAL RESPONSE AT 12 WEEKS (SVR12) — undetectable HCV RNA 12 weeks after finishing treatment. The old interferon-era endpoint was SVR24; DAA relapse after SVR12 is rare, and nearly all remain HCV RNA negative long term unless REINFECTED.
• EXAM TRAP: INTERFERON AND RIBAVIRIN ARE NO LONGER STANDARD THERAPY for hepatitis C. Clearing the virus does NOT confer immunity — reinfection is possible, so risk-reduction advice remains necessary after cure.