Hepatitis C Treatment: 98% Cure Rate in Just 12 Weeks

1. Etiology

• Pathogen: Hepatitis C virus (HCV), Flaviviridae family.
• Genotypes: 6 major types; 1b dominates in Russia (more aggressive).
• Features:
  • High mutation rate (evades immunity).
  • 80% become chronic.

2. Transmission

• Bloodborne (main route):
  • IV drug use (shared needles).
  • Unsterile tools (tattoos, piercings).
  • Blood transfusions (pre-1992).
• Sexual (rare, requires blood contact).
• Vertical (mother to child during birth, 5% risk).

Not transmitted:

• Via hugs, kissing, sharing food.
• Through breast milk (unless cracked nipples).

3. Symptoms

Acute phase (first 6 months):

• 80% asymptomatic.
• Rarely: fatigue, nausea, jaundice (20%).

Chronic form:

• Fatigue, depression.
• Abdominal discomfort, itchy skin.
• Late stages: cirrhosis, ascites, liver failure.

4. Diagnosis

1. Anti-HCV antibodies (screening, doesn’t differentiate acute/chronic).
2. HCV RNA PCR (confirms active infection).
3. Genotyping (guides treatment).
4. FibroTest/elastography (liver fibrosis assessment).

Key point:

• Post-exposure testing: 2–4 weeks (PCR), 3–6 months (antibodies).

5. Prevention

• Avoid blood contact.
• Personal hygiene items (razors, nail clippers).
• Condoms with HCV-positive partners.
• No vaccine, but cure exists.

6. Treatment

Direct-acting antivirals (DAAs):

• Sofosbuvir/velpatasvir (12 weeks, 98% cure).
• Glecaprevir/pibrentasvir (8–12 weeks).

Cure criteria:

• Sustained virologic response (SVR) — undetectable HCV RNA 12 weeks post-treatment.

7. How to Recognize?

Red flags:

• Unexplained chronic fatigue.
• Yellow skin/eyes (jaundice).
• Spider angiomas (“liver stars”).
• Abdominal swelling (ascites).

8. Post-Exposure Protocol

1. Blood on skin: Wash with soap → apply 70% alcohol.
2. Needlestick: Squeeze blood out → rinse → emergency prophylaxis (prescribed by doctor).
3. At 2 weeks: HCV RNA PCR.
4. At 3 months: Anti-HCV + PCR.

9. How to Identify HCV in Others?

Clues:

• Constant exhaustion.
• Jaundice.
• Red palmar erythema.

But:

• 80% of carriers are unaware until late stages!
• Only lab tests confirm infection.