Chronic Hepatitis C: Current Disease Management

Hepatitis C is most readily diagnosed when serum aminotransferases are elevated and anti-HCV is present in serum.

Acute Hepatitis C

Acute hepatitis C is diagnosed on the basis of symptoms of acute disease such as jaundice, fatigue, and nausea, along with marked increases in serum ALT (greater than 10-fold elevation), and presence of anti-HCV or de novo development of anti-HCV.

Diagnosis of acute disease can be problematic as anti-HCV is not always present when the patient presents to the physician with symptoms. In 30 to 40 percent of patients, anti-HCV is not detected until 2 to 8 weeks after onset of symptoms. Acute hepatitis C can also be diagnosed by testing for HCV RNA, but a more practical approach is to repeat the anti-HCV testing a month after onset of illness. HCV RNA testing should be reserved for patients with acute hepatitis in whom the diagnosis still cannot be made by conventional tests for hepatitis A, B, and C.

Chronic Hepatitis C

Chronic hepatitis C is diagnosed when anti-HCV is present and serum aminotransferase levels remain elevated for more than 6 months. Testing for HCV RNA (by PCR) can help confirm the diagnosis and documents that viremia is present; more than 95 percent of patients with chronic infection will have the viral genome detectable in serum by PCR.

Diagnosis of hepatitis C is problematic in patients who cannot produce anti-HCV because they are immunosuppressed or immunoincompetent. Thus, HCV RNA testing may be required for patients with a solid organ transplant or who are taking corticosteroids or have agammaglobulinemia. Diagnosis is also difficult in patients with anti-HCV who have another form of liver disease that might be responsible for the liver injury, such as alcoholism, iron overload, or autoimmunity. In these situations, the anti-HCV may represent a false positive reaction, previous HCV infection, or mild hepatitis C occurring on top of another liver condition.

Differential Diagnosis

The major conditions that can be confused clinically with chronic hepatitis C include

• Autoimmune hepatitis.
• Nonalcoholic steatohepatitis (fatty liver).
• Sclerosing cholangitis.
• Wilson's disease.
• Alpha-1-antitrypsin deficiency-related liver disease.
• Medication-induced liver disease.

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