From the Guidelines
Hepatitis C typically presents with minimal or no symptoms in the acute phase, with approximately 75% of cases being asymptomatic, and when symptoms occur, they include abdominal pain, nausea, anorexia, jaundice, and malaise. The natural course of hepatitis C virus infection can cause both acute and chronic hepatitis, with the first 6 months after exposure referred to as acute HCV infection 1. Without treatment, 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. Chronic infection is usually asymptomatic, although it can cause progressive liver damage, and without treatment, 15% to 30% of patients with chronic HCV infection develop cirrhosis within 20 years 1.
Some key points to consider in the presentation of hepatitis C include:
- The majority of patients are asymptomatic in the acute phase
- Symptoms, when present, are typically mild and non-specific
- Chronic infection can lead to liver fibrosis, cirrhosis, and hepatocellular carcinoma over decades
- Laboratory findings typically include elevated liver enzymes (ALT and AST), positive HCV antibody tests, and detectable HCV RNA in the blood
- Risk factors include injection drug use, blood transfusions before 1992, unsterile tattoo procedures, and certain high-risk sexual behaviors
- Diagnosis is confirmed through antibody screening followed by HCV RNA testing
- Early detection is crucial as modern direct-acting antiviral medications can cure over 95% of cases with 8-12 week treatment regimens, preventing progression to serious liver disease 1.
It is essential to prioritize early detection and treatment to prevent the progression of hepatitis C to chronic infection and its associated morbidity and mortality. The primary goal of HCV therapy is to cure the infection, i.e., to achieve a sustained virological response (SVR) defined as undetectable HCV RNA after treatment completion 1.
From the Research
Typical Presentation of Hepatitis C
The typical presentation of hepatitis C is not explicitly described in the provided studies. However, the studies do provide information on the treatment and management of hepatitis C.
Treatment and Management
- The studies suggest that ledipasvir/sofosbuvir is an effective treatment for hepatitis C genotype 1 and 4, with sustained virological response (SVR) rates of 90-99% 2, 3, 4, 5, 6.
- The treatment duration can vary from 8 to 24 weeks, depending on the patient's condition and treatment history 3, 5, 6.
- The addition of ribavirin to the treatment regimen does not appear to enhance efficacy in most cases 4, 6.
- The treatment is generally well-tolerated, with common adverse events including headache, fatigue, insomnia, nausea, and diarrhea 2, 3, 4, 5, 6.
Patient Characteristics
- The studies include patients with various characteristics, such as treatment-naive and treatment-experienced patients, patients with compensated and decompensated cirrhosis, and patients with advanced liver fibrosis 2, 3, 4, 5, 6.
- The patients' age, sex, and ethnicity are also varied, with a mean age of 59.6 years and 58.7% of patients being female in one study 6.