2.1.2 Chronic Hepatitis C

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Chronic hepatitis C presents with chronically elevated transaminases and the presence of hepatitis C RNA.

High risk groups include: intravenous/nasal drug users and homosexual HIV patients. The diagnosis is made by detecting hepatitis C antibodies. If these are positive, an additional hepatitis C RNA determination is indicated. If the RNA is negative, it concerns past hepatitis C. If the RNA is positive, which is accompanied by an increase in transaminases over time, it concerns chronic active hepatitis. 

Chronic HCV may be associated with extrahepatic manifestations. These include B-cell lymphomas, porphyria cutanea tarda, and vasculitis (mixed cryoglobulinemia associated with skin and renal lesions). Chronic active hepatitis C leads to cirrhosis in approximately 20% of patients after approximately 20 years, with a subsequent progression to hepatocellular carcinoma (HCC) of 2% per year. Chronic hepatitis C can be successfully treated with direct active antiviral medication; usually a combination of protease inhibitors, NS5A inhibitors and polymerase inhibitors. It is important to check whether the dose of the associated medication does not need to be adjusted (drug-drug interactions, polypharmacy).

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