How is hepatitis C (HCV) infection diagnosed?

Updated: Jul 14, 2021
  • Author: Joel Schifter, MD; Chief Editor: Eric B Staros, MD  more...
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The diagnosis acute of hepatitis C is suggested by the presence of clinical or biochemical evidence of acute hepatitis accompanied by anti-HCV and/or HCV RNA in serum. In most cases, the diagnosis can be made based on anti-HCV testing alone but sometimes it requires repeat testing for HCV antibody 4-6 weeks later or direct assays for HCV RNA. Neither anti-HCV or HCV RNA testing can reliably distinguish between acute and chronic HCV with a superimposed form of acute liver injury or an acute exacerbation. [6]

Approximately, 55-85% of patients who develop acute HCV remain infected. The diagnosis of chronic HCV is generally made on the basis of persistent ALT elevations or HCV RNA in serum for 6 months or longer. These patients are at risk of progression to cirrhosis and/or hepatocelullar carcinoma; this progression is accelerated in patients of older age, who are obese, who have human immunodeficiency virus (HIV), or who abuse alcohol. [6]

Appropriate screening at diagnosis can correctly identify appropriate candidates for HCV treatment with peginterferon alfa and ribavirin, preventing complications and death from HCV infection. [1]

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