What is the significance of being reactive for Hepatitis C (HCV)?

From the Guidelines

Being reactive for hepatitis C is a significant health concern as it indicates either a current active infection or a past infection that your body has cleared, and without proper treatment, it can lead to serious liver complications, including cirrhosis, liver failure, and hepatocellular carcinoma. The significance of being reactive for hepatitis C lies in the potential for the development of chronic hepatitis C, which can cause progressive liver damage over time 1. According to the most recent guidelines, approximately 15% to 45% of infected individuals spontaneously clear HCV within 6 months of infection, while those who do not clear the virus and do not receive treatment will develop chronic HCV infection 1.

Key Considerations

• Chronic HCV infection is usually asymptomatic but can cause progressive liver damage, with 15% to 30% of patients developing cirrhosis within 20 years 1.
• The risk of hepatocellular carcinoma (HCC) is significantly higher in patients with cirrhosis, with 27% developing HCC within 10 years if left untreated 1.
• Treatment with direct-acting antiviral medications can achieve a sustained virological response (SVR) in over 95% of cases, significantly reducing the risk of HCC and liver-related mortality 1.
• Even if the infection is cleared naturally, monitoring for liver health is essential, as prior infection may have caused some liver damage.

Recommendations

• If you test reactive for hepatitis C antibodies, follow-up testing with an HCV RNA test is necessary to determine if you have an active infection.
• If the RNA test is positive, treatment with direct-acting antiviral medications is recommended to achieve an SVR and reduce the risk of liver complications.
• Regular monitoring for liver health is essential, even if the infection is cleared naturally, to detect any potential liver damage early on. Treatment with direct-acting antiviral medications, such as Epclusa (sofosbuvir/velpatasvir), Mavyret (glecaprevir/pibrentasvir), or Harvoni (ledipasvir/sofosbuvir), is the current standard of care for chronic hepatitis C, and it is essential to start treatment as soon as possible to prevent long-term liver damage 1.

From the FDA Drug Label

Test all patients for evidence of current or prior hepatitis B virus (HBV) infection before initiating treatment with ledipasvir and sofosbuvir HBV reactivation has been reported in HCV/HBV coinfected patients who were undergoing or had completed treatment with HCV direct acting antivirals and were not receiving HBV antiviral therapy. Some cases have resulted in fulminant hepatitis, hepatic failure, and death.

The significance of being reactive for hepatitis C is that it indicates the patient has a current or past HCV infection. However, the provided text does not directly address the significance of being reactive for hepatitis C. It does mention the risk of HBV reactivation in patients coinfected with HCV and HBV, which can lead to severe consequences such as fulminant hepatitis, hepatic failure, and death 2, 3.

• Key points:
  • Being reactive for hepatitis C indicates current or past HCV infection
  • Patients coinfected with HCV and HBV are at risk of HBV reactivation
  • HBV reactivation can lead to severe consequences, including fulminant hepatitis, hepatic failure, and death
  • It is essential to test all patients for evidence of current or prior HBV infection before initiating HCV treatment.

From the Research

Significance of Being Reactive for Hepatitis C

The significance of being reactive for hepatitis C can be understood through several key points:

• Diagnosis and Treatment: Being reactive for hepatitis C indicates the presence of the virus, and treatment is recommended for nearly everyone with the infection 4. The goal of therapy is to slow or halt the progression of fibrosis and prevent the development of cirrhosis 5.
• Importance of Screening: Screening recommendations and treatment guidelines for hepatitis C virus (HCV) infection have been updated, and universal screening with an anti-HCV antibody test is recommended at least once for all adults 18 years and older 4.
• Consequences of Untreated Infection: Without treatment, HCV infection can lead to advanced liver disease and death 6. Chronic infection is associated with serious morbidity and mortality, such as cirrhosis and hepatocellular carcinoma 5.
• Treatment Outcomes: A sustained virologic response (SVR) is associated with lower all-cause mortality and improves hepatic and extrahepatic manifestations, cognitive function, physical health, work productivity, and quality of life 4. Treatment with direct-acting antivirals (DAAs) can achieve SVR rates of >90% 7.
• Challenges in Diagnosis: The current antibody-first, 2-step testing strategy can miss early infections and result in incomplete diagnoses 6. Advancements in hepatitis C diagnostics and the US regulatory landscape have created an opportunity to include viral-first testing strategies and improve hepatitis C diagnosis.

Key Considerations

Some key considerations for individuals who are reactive for hepatitis C include:

• Follow-up Testing: After a reactive result, follow-up testing with a nucleic acid test is necessary to detect HCV RNA and confirm the diagnosis 6.
• Treatment Options: Treatment options are available, and the choice of treatment depends on various factors, including the presence of cirrhosis and the patient's treatment history 4.
• Regular Surveillance: Regular surveillance for hepatocellular carcinoma and esophageal varices is recommended for patients with compensated cirrhosis after treatment 4.