The incubation period of hepatitis C ranges from 14-180 days, after which one of the following clinical scenarios can be observed:

Acute hepatitis C, which is frequently asymptomatic. Less than a third of patients develops non-specific symptoms such as fever, fatigue, malaise, upper abdominal pain, nausea, vomiting, and myalgia. Jaundice and dark urine may be noted. Acute hepatitis C is self-limiting, and symptoms subside after up to three months. In 50-80% of cases, though, acute hepatitic C leads to chronic infection, with the majority of patients remaining unaware of this development [1].

Chronic hepatitis C, as indicated by persistent viremia after 12-24 weeks of infection. The vast majority of individuals who acquire HCV develop a persistent infection where chronic fatigue is the principal symptom. Additional symptoms are non-specific and may comprise hepatomegaly, upper abdominal pain, nausea, vomiting and loss of appetite [2]. The systemic nature of the disease is reflected in extrahepatic manifestations, which may include immune-related disorders such as cryoglobulinemia, B-cell lymphoma, Sicca syndrome, myalgia, and arthralgia, as well as inflammatory-related conditions like diabetes mellitus type 2, membranoproliferative glomerulonephritis, polyarthritis, and fibromyalgia [3].
Jaundice, ascites, variceal bleeding, and encephalopathy with cognitive deficiencies, which are suggestive of liver disease, are not usually observed until the progression to cirrhosis [4]. Cirrhosis may develop decades after the initial infection and predisposes to the development of hepatocellular carcinoma [5]. Liver cancer may be associated with non-specific symptoms as described above, and with malaise, weight loss, and gastrointestinal complaints.

Fulminant hepatitis C. A rapid progression of acute hepatitis to fulminant hepatic failure is observed in a very few cases. It is associated with a rapid deterioration of liver function due to massive hepatic necrosis, leading to encephalopathy and multiorgan failure.

• Fatigue

  Nausea, vomiting, and fatigue can diminish your appetite, causing you to reduce the amount of food you want to eat. [verywellhealth.com]

  If symptoms do happen, they can include: Fever Fatigue (feeling very tired) Not feeling hungry Feeling nauseous, or sick to your stomach Vomiting Dark-colored urine (pee) Grey-colored bowel movements Pain in your joints Jaundice (having yellow-colored [kidneyfund.org]

  Acute HCV can cause abdominal discomfort, nausea, fatigue, and fever. Chronic HCV can lead to more severe scarring of the liver and liver cancers. [medicalnewstoday.com]

  Sofosbuvir can cause fatigue, headache, and tummy troubles and make it hard for you to sleep. Simeprevir may cause dry skin and a rash and make you more sensitive to sunlight. [webmd.com]

• Weakness

  Hepatitis C infection will continue to test both the strengths and the weaknesses in the relationship between health and corrective services in Australia. [ncbi.nlm.nih.gov]

  Existing diagnostics are too complex and/or too expensive for countries with limited budgets, weak health systems, or both. [finddx.org]

  […] may include: Permanent hearing loss and facial weakness. [mayoclinic.org]

  The condition involves a painful rash and facial muscle weakness, which is sometimes confused with a stroke. Ramsay Hunt syndrome is usually effectively treated, but some people may have permanent facial muscle weakness and hearing loss. [medicalnewstoday.com]

  Herpes zoster oticus is characterized by a painful unilateral rash of fluid-filled blisters affecting one ear and facial weakness or paralysis on the same side. [drugtopics.com]

• Malaise

  Patients with acute hepatitis C may claim fever, fatigue, malaise, upper abdominal pain, nausea, vomiting, and myalgia. [symptoma.com]

  When present, symptoms of acute illness may include fever, malaise, nausea, jaundice, arthralgia (joint pain), dark urine, pale stools, and abdominal pain. Acute symptoms typically subside within several weeks. [britannica.com]

  These symptoms include Loss of appetite A general feeling of illness (malaise) Fever Nausea and vomiting Jaundice (yellowing of the skin and whites of the eyes) Acute hepatitis C very rarely becomes severe (fulminant). [msdmanuals.com]

• Raynaud Syndrome

  syndrome Sjögren syndrome Porphyria cutanea tarda Necrotizing cutaneous vasculitis See Presentation for more detail. [emedicine.com]

• Paraumbilical Hernia

  Signs in patients with decompensated liver disease include the following: Head signs: Icteric sclera, temporal muscle wasting, enlarged parotid gland, cyanosis Fetor hepaticus Gynecomastia, small testes Abdominal signs: Paraumbilical hernia, ascites, [emedicine.com]

• Nausea

  Here, we report the case of a 62-year-old HCV GT-4 positive woman complaining of a headache, nausea, and arthralgia. [ncbi.nlm.nih.gov]

  Nausea, vomiting, and fatigue can diminish your appetite, causing you to reduce the amount of food you want to eat. [verywellhealth.com]

  Symptomatic patients may experience fatigue, nausea, anorexia, myalgia (muscle pain), arthralgia, weakness, and weight loss. [britannica.com]

  Patients with acute hepatitis C may claim fever, fatigue, malaise, upper abdominal pain, nausea, vomiting, and myalgia. [symptoma.com]

• Loss of Appetite

  In addition to some of the above symptoms, chronic hepatitis C infection may also cause: Weakness Severe fatigue Loss of appetite Testing for hepatitis C To diagnose hepatitis C, your doctor will ask about your symptoms and medical history, and perform [upmc.com]

  Cirrhosis is scarring of the liver and can lead to: jaundice loss of appetite abdominal pain weight loss bruising HCV transmission A person can contract HCV through direct contact with blood or other body fluids that contain the virus. [medicalnewstoday.com]

  If symptoms do develop, and this is rare, they can include nausea, loss of appetite, aching muscles and mild fever. Later, jaundice (a yellowing of the eyes and skin) may develop, and the urine may darken. [irishhealth.com]

  Symptoms may include: a high temperature of 38C (100.4F) or above tiredness loss of appetite tummy (abdominal) pains feeling and being sick Around 1 in 5 people who experiences symptoms will also have yellowing of the eyes and skin. [nhs.uk]

  Symptoms may be very mild and flu-like: nausea, fatigue, loss of appetite, fever, headaches, and abdominal pain. Most people do not have jaundice although jaundice can sometimes occur along with dark urine. [hepfi.org]

• Abdominal Pain

  Symptoms may include: a high temperature of 38C (100.4F) or above tiredness loss of appetite tummy (abdominal) pains feeling and being sick Around 1 in 5 people who experiences symptoms will also have yellowing of the eyes and skin. [nhs.uk]

  Patients with acute hepatitis C may claim fever, fatigue, malaise, upper abdominal pain, nausea, vomiting, and myalgia. [symptoma.com]

  If symptoms do appear, they can include: fever fatigue dark urine abdominal pain nausea vomiting loss of appetite joint pain jaundice, which is a yellowing of the skin and eyes Most people with chronic hepatitis C either show no symptoms, or their symptoms [medicalnewstoday.com]

  The acutely infected may suffer from fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, grey-coloured faeces, joint pain, and jaundice (yellowing of the skin and the whites of the eyes). [dndi.org]

  Symptoms of chronic hepatitis C can include fatigue, jaundice, abdominal pain, and joint pain. Long-term complications of HCV infection include liver cirrhosis (liver scarring) and liver cancer. [medbroadcast.com]

• Abdominal Bruit

  […] caput medusae, hepatosplenomegaly, abdominal bruit Ankle edema Scant body hair Skin signs: Spider nevi, petechiae, excoriations due to pruritus Other common extrahepatic manifestations include the following: Cryoglobulinemia Membranoproliferative glomerulonephritis [emedicine.com]

• Jaundice

  If symptoms do happen, they can include: Fever Fatigue (feeling very tired) Not feeling hungry Feeling nauseous, or sick to your stomach Vomiting Dark-colored urine (pee) Grey-colored bowel movements Pain in your joints Jaundice (having yellow-colored [kidneyfund.org]

  Pale or chalky stools In acute hepatitis, these symptoms typically resolve on their own, although more severe cases involving jaundice and choluria may take up to a year. [verywellhealth.com]

  If you have it, you might: Retain water Bleed and bruise easily Notice skin and eyes turning yellow with jaundice Does Hep C Always Become Chronic? No. [webmd.com]

  […] tool=bestpractice.com Infection may present as an acute illness (e.g., fatigue, arthralgia, jaundice) in approximately one third of patients; however, the majority of patients are asymptomatic. [bestpractice.bmj.com]

  Signs of cirrhosis can include jaundice, vomiting blood, dark poo, and a build-up of fluid in the legs or abdomen. Read more about the complications of hepatitis C. [nhs.uk]

• Hepatosplenomegaly

  Jaundice, hepatosplenomegaly, ascites, encephalopathy and gastroesophageal varices are signs of more advanced disease. Baseline laboratory test results should be obtained ( Table 2 ). [doi.org]

  […] patients with decompensated liver disease include the following: Head signs: Icteric sclera, temporal muscle wasting, enlarged parotid gland, cyanosis Fetor hepaticus Gynecomastia, small testes Abdominal signs: Paraumbilical hernia, ascites, caput medusae, hepatosplenomegaly [emedicine.com]

• Fetor Hepaticus

  Signs in patients with decompensated liver disease include the following: Head signs: Icteric sclera, temporal muscle wasting, enlarged parotid gland, cyanosis Fetor hepaticus Gynecomastia, small testes Abdominal signs: Paraumbilical hernia, ascites, [emedicine.com]

• Hepatomegaly

  Additional symptoms are non-specific and may comprise hepatomegaly, upper abdominal pain, nausea, vomiting and loss of appetite. [symptoma.com]

  The majority of infected children have intermittent or chronically elevated aminotransferase levels [14], [20], [21], with hepatomegaly being the only common physical finding [14]. [doi.org]

• Hypertension

  ING is a very rare clinicopathological disease associated with smoking, obesity and hypertension, chronic obstructive pulmonary disease and metabolic syndrome. [ncbi.nlm.nih.gov]

  Management and Treatment of Patients with Cirrhosis and Portal Hypertension Review (PDF) Recommendations from the Department of Veterans Affairs to manage and treat cirrhosis and portal hypertension based on evidence in literature, including randomized [idsociety.org]

  Technical and therapeutic advances have appeared in all areas of hepatology, in particular portal hypertension, liver tumours, genetic diseases and imaging, both diagnostic and therapeutic. [books.google.com]

  SasinParaksa / Thinkstock 9) Pixologic Studio / Science Source 10) vitapix / Thinkstock 11) David.moreno72 / Wikipedia 12) (Left to right) iStockPhoto, Getty Images, Supersmario / Thinkstock SOURCES: American Academy of Family Physicians: “Cirrhosis and Portal Hypertension [webmd.com]

  ROLE OF HYPERTENSION Hypertension is one of the main components of metabolic syndrome. [doi.org]

• Cyanosis

  Distended neck veins → pericardial tamponade, tension pneumothorax, cardiogenic failure, air embolism "Seat belt sign" → deceleration or vascular injury; chest wall contusion/abrasion Paradoxical chest wall movement → flail chest Facial/neck swelling or cyanosis [ncbi.nlm.nih.gov]

  Signs in patients with decompensated liver disease include the following: Head signs: Icteric sclera, temporal muscle wasting, enlarged parotid gland, cyanosis Fetor hepaticus Gynecomastia, small testes Abdominal signs: Paraumbilical hernia, ascites, [emedicine.com]

• Arthralgia

  Here, we report the case of a 62-year-old HCV GT-4 positive woman complaining of a headache, nausea, and arthralgia. [ncbi.nlm.nih.gov]

  […] tool=bestpractice.com Infection may present as an acute illness (e.g., fatigue, arthralgia, jaundice) in approximately one third of patients; however, the majority of patients are asymptomatic. [bestpractice.bmj.com]

  Symptomatic patients may experience fatigue, nausea, anorexia, myalgia (muscle pain), arthralgia, weakness, and weight loss. [britannica.com]

  The systemic nature of the disease is reflected in extrahepatic manifestations, which may include immune-related disorders such as cryoglobulinemia, B-cell lymphoma, Sicca syndrome, myalgia, and arthralgia, as well as inflammatory-related conditions like [symptoma.com]

  […] at risk should use latex condoms with sexual activity. 12 Diagnosis and Complications Most patients (60 to 70 percent) with HCV infection are asymptomatic; when symptoms do occur, they are non-specific and include fatigue, nausea, anorexia, myalgias, arthralgias [aafp.org]

• Myalgia

  Patients with acute hepatitis C may claim fever, fatigue, malaise, upper abdominal pain, nausea, vomiting, and myalgia. [symptoma.com]

  Symptomatic patients may experience fatigue, nausea, anorexia, myalgia (muscle pain), arthralgia, weakness, and weight loss. [britannica.com]

  Persons at risk should use latex condoms with sexual activity. 12 Diagnosis and Complications Most patients (60 to 70 percent) with HCV infection are asymptomatic; when symptoms do occur, they are non-specific and include fatigue, nausea, anorexia, myalgias [aafp.org]

  Symptoms of cryoglobulinemia include fatigue, myalgias, arthralgias, neuropathy, glomerulonephritis, and rashes (urticaria, purpura, leukocytoclastic vasculitis); asymptomatic cryoglobulinemia is more common. [msdmanuals.com]

• Pruritus

  Lerner, Topical Therapies for Pruritus, Seminars in Cutaneous Medicine and Surgery, 30, 2, (118), (2011). Howard B. Pride and Mercedes E. [oadoi.org]

  Common adverse events with telaprevir when used in combination with ribavirin and pegylated interferon include anemia, nausea, fatigue, headache, diarrhea, pruritus, and anal or rectal irritation and pain. [medscape.com]

  […] and/or feeling sick discomfort in the liver area (place your right hand over your lower right ribs and it will just about cover the area of your liver) inability to tolerate alcohol problems concentrating (brain fog) joint and muscle aches itchy skin (pruritus [britishlivertrust.org.uk]

• Petechiae

  […] temporal muscle wasting, enlarged parotid gland, cyanosis Fetor hepaticus Gynecomastia, small testes Abdominal signs: Paraumbilical hernia, ascites, caput medusae, hepatosplenomegaly, abdominal bruit Ankle edema Scant body hair Skin signs: Spider nevi, petechiae [emedicine.com]

• Palmar Erythema

  Often, the first findings are signs of cirrhosis (eg, splenomegaly, spider nevi, palmar erythema) or complications of cirrhosis (eg, portal hypertension, ascites, encephalopathy). [msdmanuals.com]

  Often, the first findings are signs of chronic liver disease (eg, splenomegaly, spider nevi, palmar erythema) or complications of cirrhosis (eg, portal hypertension, ascites, encephalopathy ). [merckmanuals.com]

  The physical examination may reveal signs of liver disease such as spider angiomata, palmar erythema and telangiectasia. [doi.org]

• Urticaria

  Symptoms of cryoglobulinemia include fatigue, myalgias, arthralgias, neuropathy, glomerulonephritis, and rashes (urticaria, purpura, leukocytoclastic vasculitis); asymptomatic cryoglobulinemia is more common. [msdmanuals.com]

  Skin reactions include Raynaud’s phenomenon, livedo reticularis, urticaria, and edema. Arthralgias more frequently involve the hands and the knees symmetrically. [doi.org]

• Yellow Discoloration of the Skin

  Signs and symptoms include: Bleeding easily Bruising easily Fatigue Poor appetite Yellow discoloration of the skin and eyes (jaundice) Dark-colored urine Itchy skin Fluid buildup in your abdomen (ascites) Swelling in your legs Weight loss Confusion, drowsiness [mayoclinic.org]

  About 6-7 weeks after exposure, the following signs and symptoms occur in a small portion of infected people: Nausea or poor appetite Stomach pain Dark-colored urine/clay-colored stools Yellow discoloration in the skin and eyes (jaundice) Fever Muscle [health.utah.gov]

• Mood Swings

  swings depression or anxiety indigestion or bloating itchy skin abdominal pain If left untreated, the infection can eventually cause the liver to become scarred (cirrhosis). [nhs.uk]

  However, symptoms of the chronic stage can include: Extreme tiredness Depression Short-term memory problems or difficulty concentrating Mood swings Digestive problems Joint and muscle aches and pains Headaches Flu-like symptoms Pain or discomfort in the [spunout.ie]

  Some non-specific symptoms of chronic disease may include ongoing flu-like symptoms, joint pains, abdominal pain, loss of appetite, changed bowel habits, mood swings and insomnia. [independent.ie]

  The symptoms are: Upper abdominal pain, especially on the right Dark urine Light colored bowel movements Jaundice (yellowing of the skin and eyes) Nausea and upset stomach Fatigue Low grade fever and chills Muscle aches Loss of appetite Mood swings Joint [emedicinehealth.com]

• Paresthesia

  It is the most frequent complication, observed in 9-45% of all cases. [4] Most people report a deep burning or aching pain, paresthesia, dysesthesia, hyperesthesia, or electric shock–like pains. [emedicine.medscape.com]

  Examples include the following: Arthralgias Paresthesias Myalgias Pruritus Sicca syndrome Sensory neuropathy Symptoms characteristic of complications from advanced or decompensated liver disease are related to synthetic dysfunction and portal hypertension [emedicine.com]

• Difficulty Concentrating

  However, symptoms of the chronic stage can include: Extreme tiredness Depression Short-term memory problems or difficulty concentrating Mood swings Digestive problems Joint and muscle aches and pains Headaches Flu-like symptoms Pain or discomfort in the [spunout.ie]

  concentrating and sleeping; emotional lability; headache; irritability; memory loss Other Local erythema, pain, or abscess at injection site NEWER THERAPIES Other interferons (consensus interferon and albinterferon alfa-2b) and ribavirin alternatives [aafp.org]

  Other possible side effects of interferon include depression, difficulty sleeping, difficulty concentrating, and irritability. The most common of these is depression. [web.archive.org]

  Other complaints include weight loss, muscle or joint pain, irritability, nausea, malaise, anorexia, depression, abdominal discomfort, difficulty concentrating, and jaundice. [clevelandclinicmeded.com]

• Dark Urine

  If you do, they may include: Belly pain Clay-colored poop Dark urine Fatigue Fever Jaundice (yellow tint to your skin or eyes) Joint pain Poor appetite Nausea Vomiting Symptoms usually show up between 2 and 12 weeks after exposure to the virus. [webmd.com]

The diagnosis of hepatitis C based solely on clinical criteria is difficult, especially in mildly symptomatic chronic carriers. For this reason, a detailed patient history is mandatory during the workup, as physicians can assess risk factors - risky sexual intercourse, intravenous drug abuse or even recent tattooing - as well as the onset and progression of symptoms. When a clinical suspicion of viral hepatitis is supported by data obtained during the anamnesis and physical examination, an extensive laboratory workup is necessary. Complete blood count and biochemical profile are drawn, comprised of serum electrolytes, liver function tests, bilirubin, albumin, and alkaline phosphatase levels, and renal parameters. In case of hepatitis C, liver enzymes may be elevated up to 10 times the normal values, and these findings warrant testing for viral hepatitis.

Serological testing for anti-HCV IgM and IgG antibodies is the basis of the diagnosis of both acute and chronic infections with HCV. However, the presence of antibodies is no proof of an active infection and may possibly be explained by a previous, yet overcome infection with HCV, and seroconversion may not occur until two months after the exposure to HCV. Thus, the effective and early confirmation of hepatitis C requires the detection of viral RNA in serum. Molecular biological studies are also preferred in the immunocompromised, who may not be able to produce detectable amounts of antibodies and who make up a considerable share of hepatitis C patients.

Co-infections with HCV, hepatitis B virus and human immunodeficiency virus are not rare occurrences, since these pathogens are transmitted via similar routes [6] [7]. Accordingly, the confirmation of hepatitis C should prompt testing for infections with the other agents. Furthermore, the diagnosis of hepatitis C requires a thorough assessment of the advancement of liver disease. Most reliable results are obtained by the histological examination of tissue samples obtained by biopsy, with diagnostic imaging playing a greater role in gaining an overview and during follow-ups.

• Hepatocellular Carcinoma

  The presentation of primary hepatocellular carcinoma with spinal cord compression is very rare. To the best of our knowledge, there are only 33 such cases published to date. [ncbi.nlm.nih.gov]

  Hepatocellular carcinoma incidence, mortality, and survival trends in the United States from 1975 to 2005. J Clin Oncol 2009 27 1485-91. Epidemiology of hepatocellular carcinoma in USA. Hepatol Res 2007 37 Suppl 2 S88-94 ,. [doi.org]

  It is a risk factor for the development of hepatocellular carcinoma (HCC). Route of transmission The most common route of transmission is through blood products and contaminated needles. [radiopaedia.org]

The development of drugs with direct antiviral activity have made hepatitis C a curable condition. The respective pharmaceuticals are well tolerated, and response rates exceed 90%. The precise treatment regimen will depend on the HCV genotype and subtype, the severity of liver disease, and the results of prior therapy, if carried out. When available, interferon-free regimens are preferred over those based on the application of peginterferon α-2a and peginterferon α-2b. Patients infected with HCV genotypes 1, 4, 5, or 6 may be provided sofosbuvir and ledipasvir, while sofosbuvir and ribavirin may be indicated if HCV genotypes 2 or 3 are detected [2] [8]. There are other compounds that are approved for hepatitis C treatment, namely simeprevir, daclatasvir, paritaprevir, ombitasvir, and dasabuvir, and the interested reader is referred to the treatment recommendations published by the European Association for the Study of the Liver: Here, guidelines are provided for the management of a number of special cases [8].

A sustained virologic response is achieved when HCV RNA is no longer detectable in the patient's serum, and the respective tests are carried out 12 and 24 weeks after the end of treatment; patients are considered to be cured if retesting after 48 weeks Still, the elimination of the causative agent does not imply the complete regression of fibrosis or cirrhosis. These conditions may improve in the absence of HCV, but patients with advanced-stage hepatitis C remain at risk of portal hypertension, hepatic failure, and hepatocellular carcinoma. Accordingly, they should be offered regular follow-ups to facilitate the early detection of a possible deterioration or malignant degeneration [8].

End-stage liver disease is an indication for liver transplantation, regardless of the provision of antiviral therapy. The preventive elimination of HCV is highly recommended, though, to prevent liver graft infection after transplantation [8].

Spontaneous clearance of HCV occurs within 6 months of infection in up to 45% of infected individuals, without treatment being provided [9]. Still, this process does not result in long-term immunity and those belonging to certain risk groups may re-contract the disease. Similarly, the elimination of HCV by means of antiviral therapy does not protect from new infections.

The prognosis of patients who receive anti-HCV therapy primarily depends on the severity of liver disease at the time of diagnosis. Fibrosis, cirrhosis, and carcinoma development are largely irreversible and often associated with a poor outcome. Fulminant hepatitis C has long since been associated with the highest mortality rates, but progress in therapy considerably improved the prognosis of affected individuals [10]. On the other hand, patients who are diagnosed and treated before the onset of irreversible liver damage have a good prognosis [11] [12].

HCV is a single strained RNA virus with pronounced genetic variability. To date, 7 genotypes and 67 subtypes have been defined [2] [9]:

• Genotype 1 accounts for almost half of HCV infections worldwide. It is particularly common in developed countries.
• Genotype 3 is the second most common variant of HCV. It accounts for about a third of all cases and is mainly detected in South Asia, Europe, and the Americas.
• Genotypes 2 and 6 account for greater shares of infections in East Asia, while genotype 4 is mainly found in Africa and the Middle East.
• Genotype 5 has been related to some infections in Southern Africa, and genotype 7 has been defined after being isolated from a patient originating from the Democratic Republic of Congo [13].

HCV is transmitted through blood and blood products, and via the sexual route. Accordingly, intravenous drug abuse and needle-sharing, as well as unprotected sexual activity are considered risk factors for hepatitis C. In both settings, concomitant immunodeficiency significantly increases the risk of HCV transmission. Those who receive infected blood products, undergo invasive procedures, receive piercings or tattoos in facilities with inadequate infection control practices may also contract the disease, but iatrogenic hepatitis C has become less frequent. Vertical transmission, on the other hand, is the principal mode of virus acquisition in children. Children born to affected mothers thus form another risk group. The risk of vertical HCV transmission has been estimated at <10% in the absence of the human immunodeficiency virus but may rise to 25% in case of co-infections.

Hepatitis C is a major public health concern, and it has been estimated that there are about 160 million persons with serological evidence of current or past HCV infection [8]. Each year, up to 700,000 patients die from this disease. Prevalence rates are highest in lower and middle-income countries, in Sub-Saharan Africa and Eastern Europe, where insufficient safety measures contributed to the iatrogenic spread of hepatitis C [9]. Still, the primary reason for the high number of cases on a global scale is the insidious nature of the infection, as up to 85% of infected individuals develop a stable chronic infection that tends to go unnoticed [14].

Acute HCV infections rapidly trigger an innate immune response. However, HCV alters the host defense and innate immunity through a variety of complementary mechanisms, thereby facilitating chronic infection. Neutralizing antibodies against HCV are produced from the second month after infection, but it has not yet been clarified whether these antibodies suffice for viral clearance. On the other hand, weak, delayed, or transient CD4+ and CD8+ T-cell responses have been identified as causes of persistent infection. The inhibition of T-cell response might be mediated by the infection of dendritic cells, or by the direct inhibition of T-cell differentiation and maturation, but further research is required to confirm these hypotheses. Those patients who can overcome the infection show year-long sustained, vigorous, and HCV-specific T-cell responses [5].

Initially, the very high cost of direct antivirals severely limited the access to curative treatment, but substantial price reductions have opened up the opportunity for appropriate management even in resource-limited settings. Unfortunately, though, the majority of hepatitis C patient develops chronic liver disease and remains unaware of the infection. Comprehensive screenings may be required to unveil millions of cases of subclinical hepatitis C, which is a prerequisite to reach the ambitious goal of globally eliminating the disease within the next decades. To date, the costs of HCV diagnostics may exceed those of curative therapies, and further research is required to facilitate the development of specific, sensitive, and affordable tools that may close that gap [14].

On an individual scale, the correct and consistent use of condoms and the avoidance of exposure to blood and blood products are the best options to prevent infection with HCV. Those at risk should regularly be tested, e.g., medical personnel, health-care workers, tattooists, sex workers, and immunodeficient patients.

Hepatitis C is a sexually transmissible disease and major public health concern. According to estimates, there are >150 million people infected with HCV. While acute symptoms may develop, the disease usually follows a chronic course. Chronic hepatitis C may be associated with constitutional symptoms, gastrointestinal complaints, and immune disorders, among others. The absence of liver-specific symptoms contributes to long delays in diagnosis, where the majority of patients remains unaware of the infection until decades after the acquisition of HCV. During that time, they may infect others, and they are likely to develop fibrosis and cirrhosis. Cirrhosis, in turn, is a major risk factor for hepatocellular carcinoma.

The introduction of drugs with direct antiviral activity as well as recent price reductions put a cure within reach of many patients who did not yet develop irreversible liver damage. The latter may require liver transplantation, but even those patients will benefit from pangenotypic anti-HCV therapy. Current challenges thus consist in raising awareness, increasing detection rates, and providing effective treatment to the highest possible number of patients. This way, hepatitis C may eventually be eradicated on a global scale.

Hepatitis C is a major public health concern. It is a sexually transmissible disease, but hepatitis C virus may also be acquired when exposed to blood or blood products, when needles are shared by intravenous drug users, or when children are born to infected mothers. Symptoms of acute infection are not usually developed and don't suggest liver disease. Patients with acute hepatitis C may claim fever, fatigue, malaise, upper abdominal pain, nausea, vomiting, and myalgia. These symptoms typically subside after several weeks, and the patients assume to be cured of whatever disease they had contracted. In fact, however, the infection persists. Over the course of decades, chronic hepatitis C may manifest in distinct constitutional symptoms, gastrointestinal complaints, and immune disorders. Symptoms suggestive of liver disease may not be developed until irreversible damage occurs, until the patient suffers from liver fibrosis, cirrhosis, or even cancer. What's more, while unaware of the infection, patients may infect others.

The causes of symptoms consistent with acute or chronic hepatitis C should thus be clarified. What's more, good outcomes are linked to an early diagnosis and timely initiation of treatment. Those who prevent an infection in the first place have the best prognosis, though: The acquisition of hepatitis C virus can be avoided by the consistent use of condoms and the responsible handling of potentially infective materials.

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