Diagnosis and Treatment of Hepatitis C

Approximately 2.4 million people in the United States have hepatitis C, a bloodborne disease caused by the hepatitis C virus (HCV). Over 50 percent of cases progress from acute to chronic infection, which can lead to long-term illness and death when left untreated. According to the US Preventive Services Task Force, adults between ages 18 and 79 should undergo screening for hepatitis C. Moreover, early treatment is critical to prevent disease advancement and chronic hepatis C-induced outcomes such as liver cancer and failure.

Most people with HCV infection do not show symptoms, and symptoms are often nondescript when they begin to show. At both disease stages, these may include fatigue, nausea, abdominal pain, and weight loss. Many people with chronic hepatitis C remain undiagnosed for years because symptoms do not begin to manifest until secondary or severe liver damage occurs. As such, HCV antibody and confirmatory testing should be performed following abnormal laboratory findings or indicators of late-stage liver scarring.

The diagnosis of a HCV infection constitutes a two-part process. First, a blood test in search of anti-HCV antibodies is conducted on the patient. This is called a serological test, which doctors use to identify exposure to the hepatitis C virus. If the antibody test returns positive, then it is followed by another blood test to check for current infection. Confirmatory testing also determines the stage of disease by measuring viral quantities in the patient’s blood. Upon a chronic hepatitis C diagnosis, doctors also perform a liver biopsy and other diagnostic assessments to evaluate the extent of liver damage.

Managing hepatitis C and choosing the right treatment depends on how seriously damaged the liver is. When the infection advances to chronic, patients will need treatment. Therapies for chronic hepatitis C aim to delay or stop the progression of liver damage and avoid severe liver scarring. Although no vaccination is currently available to prevent infection with the hepatitis C virus, anyone already infected should receive hepatitis A and B vaccinations to reduce risk of further complication.

To cure hepatitis C, patients can take antiviral drugs designed to clear the virus from their body. The objective of these medications is for no detectable levels of the virus to remain at least three months after the patient completes their prescribed regimen. Further, certain factors affect which medications patients should use and the length of treatment. These include the genotype of the HCV, the degree of liver damage, and medical history.

Since 2013, direct-acting antiviral (DAA) medications have become standard in the treatment of HCV infection. These drugs prove effective for most cases of chronic and acute hepatitis C, and they help patients recover faster compared to earlier therapies. DDAs also cause minimal side effects for most people.

However, patients with severe complications due to chronic hepatitis C may need to undergo liver transplantation. This procedure alone cannot fully remove the hepatitis C virus from the body in most cases. The chances of the infection resurfacing make antiviral treatments essential to protect the transplanted liver from further damage and cure the disease post-surgery.