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Hepatitis C: An Overview

Prevalence | Incidence | Demographics | Natural History | Transmission
Prevention | HCV Testing | Treatment | What You Need To Know

Natural History

What is the natural history of infection?

  • Natural History - Acute Infection
    • Symptoms
      • Are uncommon
      • On average, appear 6 to 7 weeks after infection.
    • Testing
      • 6 to 8 weeks: Average time antibodies can be detected.
      • 1 to 3 weeks: Average time virus can be detected.
      • 4 to 12 weeks: Often elevation in ALTs
    • 15 to 25 percent of people resolve acute infection
  • Serologic Pattern of Acute HCV Infection with Recovery Graph
  • Chronic Infection
    • 75 to 85 percent of infected people develop chronic infection.
    • Diagnosed by the detection of HCV RNA in the blood for at least six months.
    • 60 to 70 percent of people will have persistent or fluctuating ALT elevations.
    • Chronic liver disease usually progresses at a slow rate without symptoms.
    • The rate of progression is highly variable.
  • Chronic Infection
    • Progression can move from fibrosis to cirrhosis to end-stage liver disease and death.
    • Estimated that 10 to 20 percent of people will develop cirrhosis 20 to 30 years after infection.
    • Some with cirrhosis:
      • Develop HCC – 1 to 4 percent a year
      • Develop decompensated cirrhosis
    • End-stage liver disease necessitates a transplant or will end in death.
  • Serologic Pattern of Acute HCV Infection with Progression to Chronic Infection Graph
  • Factors that Influence Progression
    • Greater than age 40 at time of infection
    • Male gender
    • Alcohol use
    • Co-infection with HIV or HBV
    • Co-morbid conditions such as obesity or NASH
  • Factors that Don’t Influence Progression
    • Viral load
    • Genotype

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