Hepatitis C: An Overview

Natural History

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