Hepatitis C is caused by the hepatitis C virus (HCV), primarily transmitted through parenteral routes like needle sharing and blood transfusions. Many individuals remain asymptomatic until cirrhosis develops over decades, with risk factors including male gender and immunosuppression. Diagnosis involves antibody tests, liver function tests, and imaging, while treatment options are available for chronic cases.

1. HEPATITIS C

2. Etiology
Pathogen - Hepatitis C virus (HCV: RNA virus, flavivirus)
Transmission
1. Parenteral
○ Needle sharing among IV drug users
○ Needlestick injury (e.g., health care workers)
○ Organ transplantation, dialysis, blood transfusion
2. Sexual: rare (in contrast to HBV and HIV)
3. Perinatal (vertical)
High-risk groups for HCV infection
● IV drug users (especially long-time users)
● Hepatitis B virus (HBV) or HIV-positive individuals
● Recipients of blood transfusions or organ transplants

3. Clinical features
● Most people remain asymptomatic until progression to cirrhosis occurs, fatigue can complicate chronic
infection and is unrelated to the degree of liver damage.
● If hepatitis C infection is left untreated, progression from chronic hepatitis to cirrhosis occurs over 20–
40 years.
● Risk factors for progression include
○ male gender,
○ immunosuppression (such as co-infection with HIV),
○ prothrombotic states and
○ heavy alcohol misuse.
● Once cirrhosis is present, 2–5% per year will develop primary hepatocellular carcinoma.
● Symptoms
❖ Malaise, fever, myalgias, arthralgias
❖ RUQ pain, tender hepatomegaly
❖ Nausea, vomiting, diarrhea
❖ Jaundice, possibly pruritus

4. Extrahepatic features
● Hematological: mixed cryoglobulinemia, monoclonal gammopathies, lymphoma
● Rheumatological: membranoproliferative glomerulonephritis, polyarteritis nodosa,
Sjögren syndrome
● Dermatological: porphyria cutanea tarda, lichen planus
● Others: diabetes mellitus, thyroiditis, sialadenitis

5. Investigation
1. EIA/ELISA for anti-HCV antibodies: positive in cases of acute, chronic, and previous HCV infection
2. PCR for HCV RNA if antibodies are positive.
3. Liver function tests
i. ↑ Transaminases with AST/ALT ratio
Ratio < 1: acute hepatitis
Ratio ≥ 1: chronic hepatitis
i. ↓ Total protein/albumin, coagulation (particularly ↑ prothrombin time), ↓ cholinesterase
ii. Cholestasis parameters: ↑ γ-GT, ↑ alkaline phosphatase, ↑ bilirubin
1. Inflammation markers: leukocytosis, ↑ ferritin
2. Liver biopsy
indications
i. If diagnosis is inconclusive
ii. For evaluating fibrosis in patients with chronic hepatitis C
iii. Evaluation of response to therapy
1. Ultrasound: detection of cirrhosis and neoplasia, e.g., HCC
2. Rule out coinfections: HIV, hepatitis A virus (HAV), hepatitis B virus (HBV) serology necessary

7. Treatment