Hepatitis C is a bloodborne infection of the liver caused by the hepatitis C virus (HCV), a small RNA virus in the Flaviviridae family. Infection begins acutely, but the acute illness is usually mild or silent. The form that matters clinically is chronic infection, which persists in most people and can progress over years to decades to cirrhosis (scarring of the liver) and hepatocellular carcinoma (primary liver cancer). Unlike hepatitis B, there is no vaccine, but the infection can now be cured, so the main obstacle to care is finding the people who carry it.
The infection is best understood in sequence. The virus and its variability explain why the immune response so often fails, and persistence explains why finding, curing and preventing infection are the central clinical questions.
Where to start
Start with the virus and how it reaches and persists in the host:
- Hepatitis C and G viruses — the virus itself: its structure, genome, and the variability that has blocked a vaccine.
- Transmission and epidemiology of hepatitis C — how HCV spreads, and how its burden differs between regions and populations.
- Pathogenesis of hepatitis C — how the virus enters liver cells and evades innate and adaptive immunity to persist.
Then follow the patient from illness to cure:
- Clinical syndromes and natural history of hepatitis C — the acute illness, the shift to chronic infection, and the long-term course.
- Diagnosis and screening of hepatitis C — who to test, and how antibody and RNA testing identify current infection.
- Treatment of hepatitis C — the direct-acting antivirals and the goal of eradicating the virus.
Finish with what infection can cause and how to stop it:
- Complications of hepatitis C — cryoglobulinemia, skin and metabolic disorders, and hepatocellular carcinoma.
- Prevention of hepatitis C — how new infections are prevented when there is no vaccine.