Clinical features

Acute hepatitis C

• after exposure to hepatitis C virus, about 20% of patients will develop acute hepatitis (1).
• symptoms, when present, are generally mild and only 10% become jaundiced, usually within 6-9 weeks. Others may have an asymptomatic elevation of serum transaminase levels.
• specific antibodies to hepatitis C are usually detectable by 3 months after infection although, in some people, such as those who are immunocompromised, it may be up to 6 months before antibody response is detectable
• recognition of viral HCV RNA (using PCR) may be the only indicator of early infection (3)
• symptoms are seen in only around 25 to 35% of patients during the early stages and severe symptoms are rarely experienced
• patients with symptomatic acute infection may present with features like - malaise, fatigue, lethargy, anorexia, abdominal pain, jaundice, mild hepatosplenomegaly, maculopapular rash and arthralgia (4)
• rare cases of fulminant hepatitis associated with non-A non-B hepatitis have been found not to be related to HCV
• spontaneous recovery occurs in 30-50% of patients usually within 3 months (3)

Chronic hepatits C

• up to 85% of patients exposed to the virus, progress to chronic infection (1).
• chronic hepatitis C (defined as the persistence of the virus in blood after 6 months) is usually asymptomatic in the early stages and so patients present with advanced liver damage
• the rest of infected individuals clear the infection spontaneously but will remain hepatitis C antibody-positive
• symptoms when present will include mild to severe fatigue, muscle aches, nausea, depression, or anxiety, pain or discomfort at the liver and poor memory or concentration (3)
• 20-30% of chronically infected patients develop cirrhosis of the liver within 20 years (1). Cirrhosis is a risk factor for hepatocellular carcinoma
  • disease progression tends to be more rapid in men, people aged over 40 years at the time of infection, heavy drinkers, people who are obese and those with underlying immunosuppression such as HIV infectiond
  • disease progression seems to be less likely in African-Americans than in Caucasians
  • patients with cirrhosis due to hepatitis C infection have around a 1-2% annual risk of developing hepatocellular carcinoma

Reference:

• (1) NICE (October 2000). Guidance on the use of Ribavirin and Interferon Alpha for Hepatitis C.
• (2) Drug and Therapeutics Bulletin 2005; 43(3):22-24.
• (3) Royal College of General Practitioners (RCGP) 2007. Guidance for the prevention, testing, treatment and management of hepatitis C in primary care
• (4) Wong T, Lee SS. Hepatitis C: a review for primary care physicians. CMAJ. 2006;174(5):649-59