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Last Updated: 11/18/2015  

Hepatitis C

Hepatitis C virus is a leading cause of chronic liver disease. Worldwide, an estimated 180 million people are infected. In the U.S., approximately 4.1 million persons are positive for anti-HCV antibody and 80% of these are estimated to be viremic.

  • Screen patients born between 1945 and 1965 at least once, and screen those who are at increased risk for hepatitis C periodically.

  • Screen patients with test for anti-HCV antibody by ELISA; if positive, perform HCV RNA testing to confirm active infection.

  • Test patients with signs or symptoms of liver disease for hepatitis C using anti-HCV antibody by ELISA; if positive, perform HCV RNA testing to confirm active infection.

  • HCV RNA test should be performed if HCV infection is suspected but anti-HCV antibody test is negative in patients who are immunocompromised (e.g. chronic renal failure, HIV patients, and organ transplant recipients) or suspected of having acute HCV infection.

  • Consider other causes of acute or chronic liver disease when evaluating for HCV.

  • Consider other disease processes that may be complications of hepatitis C infection.

  • Consider an appropriate regimen of antiviral drug therapy for patients with chronic hepatitis C.

  • Test for immunity to HAV and HBV infection, and vaccinate susceptible patients.

Patient Education
  • Educate patients about the following:

    • Advisability of discontinuing all alcohol use

    • Typically slow progression of liver disease in chronic hepatitis C in the absence of ongoing alcohol use or other risks for progression

    • Treatment associated side effects

    • Routes of HCV transmission and ways to avoid transmission

DOI: 10.7326/d163
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Author(s) and Disclosures:
Raymond S. Koff, MD has nothing to disclose. Andrew Muir, MD received honorarium from Schering Plough, is part of speakers bureau of Schering Plough, received grants from Schering Plough, and has grants pending from Roche. Donald Gardenier, DNP, FNP, FAANP, FAAN has nothing to disclose.

One or more of the present or past ACP Smart Medicine physician editors worked on this module and had nothing to disclose: Davoren Chick, MD, FACP; Deborah Korenstein, MD, FACP; Marjorie Lazoff, MD, FACP; Richard Lynn, MD, FACP.

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