Highlights
- Early detection and treatment of hepatitis C can lead to a nearly complete cure.
- Targeted public health strategies are essential for reducing hepatitis C's burden in vulnerable populations.
Summary and Overview of Hepatitis C
Hepatitis C is a liver disease caused by the hepatitis C virus (HCV), transmitted mainly through infected blood via injection drug use, unsafe medical practices, and historically unscreened blood transfusions. Chronic infection affects millions worldwide and can lead to liver fibrosis, cirrhosis, and cancer. Early infection is often asymptomatic, complicating diagnosis. Detection relies on identifying HCV RNA before antibodies develop, enabling timely treatment with direct-acting antivirals (DAAs) that achieve cure rates over 90%. High-risk groups include people who inject drugs, incarcerated individuals, healthcare workers, and those born before routine screening implementation. Global efforts focus on expanded screening, harm reduction, and equitable treatment access to eliminate hepatitis C by 2030.
Early Recognition, Symptoms, and Risk Factors
Early diagnosis is vital for preventing liver damage and reducing transmission. HCV RNA appears before antibodies, so RNA-based testing improves early detection. Symptoms, when present, are usually mild and nonspecific, including fatigue, nausea, jaundice, and abdominal pain; many remain asymptomatic. Key risk factors include injection drug use, unsafe medical exposures, unscreened transfusions before 1992, perinatal transmission, and occupational exposures. Additional high-risk groups include people living with HIV, incarcerated populations, and those with tattoos or piercings from non-sterile equipment. Prior infection does not confer immunity, underscoring the need for targeted testing in vulnerable populations.
Pathophysiology and Immune Response
HCV replicates rapidly, with RNA detectable within one week of exposure. The virus delays adaptive immune responses, typically appearing 8 to 12 weeks post-infection. Innate immunity, including natural killer cells and interferon-stimulated genes, plays a key early role but may contribute to viral persistence. Toll-like receptor 3 activation triggers inflammatory responses in infected liver cells. The balance of these immune mechanisms influences whether infection resolves or becomes chronic.
Diagnosis and Screening
Initial screening uses HCV antibody tests, which indicate exposure but cannot distinguish active infection. Positive antibody results require confirmatory HCV RNA testing to detect current infection, which can be identified as early as 1 to 2 weeks post-exposure. Universal one-time screening is recommended for all adults and during every pregnancy, with periodic testing for high-risk individuals. WHO advises targeted testing in high-prevalence and at-risk groups. Because symptoms are often absent, proactive screening is essential for timely diagnosis and treatment linkage.
Management and Treatment
Highly effective DAAs have transformed hepatitis C treatment, achieving cure rates above 90%. Retreatment options exist for patients with prior treatment failure. Despite this, treatment access remains limited due to asymptomatic infections, healthcare barriers, and systemic gaps. National and global elimination strategies prioritize expanded screening and treatment access. Comprehensive care includes counseling and education to improve adherence and reduce risk behaviors, tailored to individual needs.
Prevention and Prognosis
Prevention focuses on avoiding contact with infected blood through harm reduction strategies such as sterile needle use and ensuring blood screening, as no vaccine currently exists. Most acute infections become chronic, leading over years to liver fibrosis, cirrhosis, and increased risk of liver cancer. Factors accelerating disease progression include alcohol use, co-infections, certain viral genotypes, and metabolic conditions. Early diagnosis and antiviral therapy significantly improve outcomes and reduce healthcare costs by preventing advanced liver disease.
Public Health Strategies and Education
Global elimination goals emphasize early detection, treatment access, and stigma reduction. Removing treatment restrictions and providing supportive care promotes equitable access. Educational programs for healthcare providers and public awareness campaigns improve knowledge and testing uptake. Innovative initiatives like Project ECHO connect specialists with community providers to enhance care for affected populations. These combined efforts support hepatitis C elimination as a public health threat by 2030.
The content is provided by Jordan Fields, Scopewires
