Hepatitis C

About Hepatitis C

Hepatitis C is caused by the hepatitis C virus HCV, identified in 1989. WHO estimated that about 50 million people were living with chronic HCV infection in 2022, with around 240,000 deaths that year, mainly from cirrhosis and liver cancer. The virus is transmitted primarily through blood, including injection drug use sharing needles, blood transfusions before screening began in 1992, needlestick injuries, and rarely from mother to child during birth. Sexual transmission is uncommon in monogamous heterosexual couples but more common in HIV positive men who have sex with men. Approximately 70 to 85 percent of HCV infections become chronic, as the virus mutates rapidly, evading immune clearance. Many patients are asymptomatic for decades until liver damage becomes advanced. When symptoms occur, they include fatigue, joint pain, itching, and abdominal discomfort. Advanced liver disease causes jaundice, ascites, easy bruising, and confusion. Extrahepatic manifestations include mixed cryoglobulinemia causing vasculitis, kidney disease membranoproliferative glomerulonephritis, diabetes, and porphyria cutanea tarda. Diagnosis involves HCV antibody screening followed by HCV RNA viral load to confirm active infection. Genotyping is needed less often now that pangenotypic treatments are available. The introduction of direct acting antivirals DAAs has transformed hepatitis C treatment. Sofosbuvir ledipasvir Harvoni, glecaprevir pibrentasvir Mavyret, and sofosbuvir velpatasvir Epclusa cure over 95 percent of infections with a course of oral treatment lasting a few months and few side effects. This represents one of the greatest triumphs of modern medicine. The WHO aims to eliminate HCV by 2030 through treatment and harm reduction.