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Source: Deming P. Viral hepatitis. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. Accessed April 10, 2017.


  • Acute or chronic viral infection of liver.


  • RNA virus, Flaviviridae family.


  • Chronic infection develops in majority of cases (75–85%).1

    • Immune response insufficient to eradicate rapidly diversifying virus.

    • Infected hepatocytes undergo apoptosis.2

      • Extent of hepatocyte apoptosis may correlate with extent of disease.

      • Liver damage and hepatocellular carcinoma (HCC) associated with high levels of apoptosis.

      • Viral persistence associated with low levels of apoptosis.


  • Most common blood-borne pathogen.

  • Infection transmission routes.

    • Parenterally.

      • Injection-drug use.

      • Other illicit-drug use.

    • Sexual contact.

      • Multiple sexual partners (inefficient)1

      • Coinfection with sexually transmitted infections (STIs)

    • Household exposure, such as sharing personal items (inefficient)1

    • Occupational exposure.


  • Screening recommended in high-risk groups (Table 1)

  • No vaccine available.

TABLE 1.Recommendations for Hepatitis C Virus (HCV) Screening


  • Sexual contact.

  • Injection-drug users.

  • Household contact with HCV-positive person.

  • Blood transfusion or transplant before 1992

  • Clotting factors administered before 1987

  • Chronic hemodialysis.


  • Acute HCV infection.

    • Most patients asymptomatic and undiagnosed.

    • Symptoms occur in one-third of adults 4–12 weeks after infection.1

  • Chronic HCV infection.

    • Defined as persistently detectable HCV RNA for 6 months or more.

    • Develops in majority of patients (75–85%).1


  • Acute HCV infection.

    • Fatigue.

    • Anorexia.

    • Weakness.

    • Jaundice.

    • Abdominal pain.

    • Dark urine.

    • Clay-colored stool.

    • Loss of appetite.

    • Nausea and vomiting.

    • Joint pain1

    • Rarely progresses to fulminant hepatitis.

  • Chronic HCV infection.

    • Persistent fatigue most common symptom.

    • Additional symptoms.

      • Right upper quadrant pain.

      • Nausea.

      • Poor appetite.

  • Physical examination.

    • Hepatomegaly.

    • Stigmata of liver disease in advanced disease.

      • Spider nevi.

      • Splenomegaly.

      • Palmar erythema.

      • Testicular atrophy.

      • Caput medusae.

    • Necroinflammatory disease on liver biopsy.

      • Fibrosis.

      • 20–30%3 develop cirrhosis.

      • Patients with cirrhosis have a 2–5% annual ...

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