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Hepatitis C

BMJ 2017; 358 doi: (Published 06 July 2017) Cite this as: BMJ 2017;358:j2861
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  1. Jawad Ahmad, professor of medicine
  1. Division of Liver Diseases, Mount Sinai Hospital, New York, NY, USA
  1. Correspondence to: J Ahmad jawad.ahmad{at}

What you need to know

  • After acute exposure to hepatitis C virus (HCV), about 55% to 85% of patients develop chronic hepatitis C

  • Most acute and chronic infections are asymptomatic; however, hepatic inflammation is often present and can lead to progressive hepatic fibrosis

  • The goal of treatment is to eradicate the virus, achieve a sustained virological response, and prevent disease progression

  • Interferon based treatment regimens are no longer recommended for HCV infection as oral, direct acting antiviral agents are now considered first line therapy

  • Long term complications of chronic HCV infection include cirrhosis and hepatocellular carcinoma

Infection with hepatitis C virus (HCV) presents as an acute illness (such as fatigue, arthralgia, jaundice) in about a third of patients, but most patients are asymptomatic. After acute infection, up to 45% of young healthy patients may develop a vigorous antibody and cell mediated immune response, which leads to the spontaneous eradication of the virus.1 However, most infected patients fail to clear the virus. This results in chronic infection and progressive liver damage.

How common is it?

Hepatitis C seems to be endemic in most parts of the world. The total global prevalence is estimated to be about 1.6%, corresponding to 115 million previous viraemic infections, but there is considerable geographical and age variation in the incidence and prevalence of infection and of genotypes.23 The prevalence may be as high as 5-15% in some parts of the world, and different regions have a different risk profile and age demographic.4 The prevalence is higher in specific populations, such as people who are incarcerated or institutionalised.5

What causes it?

Hepatitis C virus (HCV) is an infectious, hepatotropic virus belonging to the Flavivirus family, and is transmitted by percutaneous blood exposure. The most common worldwide cause is unsafe injection practices during medical treatment.6 Infection is also common in people who inject drugs. …

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