Hepatitis C virus

Last revised by Henry Knipe on 15 Dec 2022

Hepatitis C virus (HCV) is an RNA virus and a member of the Flaviviridae family. It is a risk factor for the development of hepatocellular carcinoma (HCC).

The most common route of transmission is through blood products and contaminated needles. Unprotected sex is less common and transmission through this route is controversial. Vertical transmission is a less common means of transmission.

  • HCV-1: most common overall

  • HCV-2

  • HCV-3

  • HCV-4: more common in Africa

  • HCV-5

  • HCV-6

Vaccination has not been developed for the virus.

Hepatitis C-induced cirrhosis is the most common cause of liver transplant in North and South America, Australia, Europe, and Japan. Patients with chronic hepatitis C may benefit from a hepatocellular carcinoma screening program.

Medications to treat hepatitis C are an active area of research. Antiviral medications (such as pegylated interferon and ribavirin) have shown good effectiveness in sustained virologic response, but the choice of medication depends on multiple factors including the presence and degree of cirrhosis. Interferon-free regimens have shown promising results in genotype 1 patients 4

The hepatitis C virus was first isolated in 1989 2. Many cases of chronic infection took place before the virus could be effectively screened from blood products in the 1970s and 1980s. Even though it was not isolated before 1989, its presence was known, and it was referred to as "non-A non-B hepatitis".

Acute infection with the hepatitis C virus may result in acute hepatitis.

Chronic infection with hepatitis C (>6 months) is a risk factor for the development of cirrhosis and hepatocellular carcinoma (HCC). There is a 17x risk of HCC in patients infected with hepatitis C than with non-infected controls 3.

The virus increases the risk of cirrhosis and hepatocellular carcinoma through chronic inflammation. Unlike hepatitis B (a DNA virus), hepatitis C cannot integrate into the host genome and instead causes a constant inflammatory reaction.

Chronic infection with hepatitis C can also cause extrahepatic manifestations like type 2 cryoglobulinaemia, B-cell non-Hodgkin lymphoma, primary hypothyroidism, autoimmune disorders, and insulin resistance.

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Cases and figures

  • Case 1: HCV-associated renal lymphoma
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