Hepatitis C

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Hepatitis C is "inflammation of the liver in humans caused by hepatitis c virus, a single-stranded RNA virus. Its incubation period is 30-90 days. Hepatitis C is transmitted primarily by contaminated blood parenterally, and is often associated with transfusion and intravenous drug abuse. However, in a significant number of cases, the source of hepatitis C infection is unknown."[1]


In diagnosis of cirrhosis (Ishak scores, 5-6) in patients with hepatitis C, the aspartate aminotransferase to platelet ratio index (APRI) ratio > 1 suggests cirrhosis with accuracy of:[2]

  • Sensitivity = 79%
  • Specificity = 78%


Clinical practice guidelines are available.[3]

Most studies have examined the outcome of sustained virologic response. The Cochrane Collaboration raises the question of whether this is an adequate outcome[4] due to a trial that showed virological benefit but not clinical benefit.[5]

Direct acting antiviral (DAA)

Direct acting antiviral (DAA) also called Specifically Targeted Antiviral Therapy for HCV (STAT-C) target HCV viral nonstructural proteins essential to replication and life of the virus.

NS3 protease inhibitors

Randomized controlled trials of protease inhibitors against the NS3/4A serine protease for hepatitis C genotype 1 infection. [6] [7] [8] [9]
Trial Patients Intervention Comparison Outcome Results
Intervention Control
ADVANCE Study[6]
Previously untreated patients telaprevir peginterferon-ribavirin HCV RNA 24 weeks after last treatment 69% to 75% 44%
REALIZE Study[7]
Previously treated patients telaprevir peginterferon-ribavirin HCV RNA 24 weeks after last treatment 83% to 88% (prior response)
54% to 59% (prior partial response)
29% to 33% (prior non-response)
24% (prior response)
15% (prior partial response)
5% (prior non-response)
SPRINT-2 study[8]
Previously untreated patients boceprevir peginterferon-ribavirin HCV RNA level 59% to 66% 21%
HCV RESPOND-2 study[9]
Previously treated patients boceprevir peginterferon-ribavirin HCV RNA level 67% to 68% (nonblack patients)
42% to 53% (black patients)
40% (nonblack patients)
23% (black patients)

Two NS3/4A serine protease inhibitors, telaprevir and boceprevir may add benefit to standard therapy of genotype 1 infection with peginterferon and ribavirin. Telaprevir adds to peginterferon and ribavirin for previously treated[6] and untreated[7] patients. Boceprevir adds to peginterferon and ribavirin for previously treated[9] and untreated[8] patients.

The NS3 protease inhibitor, asunaprevir, might help treat hepatitis C.[10]

The NS3/4A protease inhibitor, BI 201335, might help treat hepatitis C.[11]

NS5 replication complex inhibitors

The NS5A replication complex inhibitor, daclatasvir, might help treat hepatitis C.[10]

The NS5B replication complex inhibitor, BI 207127, might help treat hepatitis C.[11]


The United States Centers for Disease Control and Prevention issued draft recommendation for screening individuals born between 1945 and 1965.[12]


  1. Anonymous (2015), Hepatitis C (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. Gara N, Zhao X, Kleiner DE, Liang TJ, Hoofnagle JH, Ghany MG (2013). "Discordance among transient elastography, aspartate aminotransferase to platelet ratio index, and histologic assessments of liver fibrosis in patients with chronic hepatitis C.". Clin Gastroenterol Hepatol 11 (3): 303-308.e1. DOI:10.1016/j.cgh.2012.10.044. PMID 23142332. Research Blogging.
  3. Recommendations for Testing, Managing, and Treating Hepatitis C. Available at: http://hcvguidelines.org/
  4. Brok J, Gluud LL, Gluud C (2010). "Meta-analysis: ribavirin plus interferon vs. interferon monotherapy for chronic hepatitic C - an updated Cochrane review.". Aliment Pharmacol Ther 32 (7): 840-50. PMID 20839385[e]
  5. Di Bisceglie AM, Shiffman ML, Everson GT, Lindsay KL, Everhart JE, Wright EC et al. (2008). "Prolonged therapy of advanced chronic hepatitis C with low-dose peginterferon.". N Engl J Med 359 (23): 2429-41. DOI:10.1056/NEJMoa0707615. PMID 19052125. PMC PMC2606037. Research Blogging.
  6. 6.0 6.1 6.2 Zeuzem S, Andreone P, Pol S, Lawitz E, Diago M, Roberts S et al. (2011). "Telaprevir for retreatment of HCV infection.". N Engl J Med 364 (25): 2417-28. DOI:10.1056/NEJMoa1013086. PMID 21696308. Research Blogging.
  7. 7.0 7.1 7.2 Jacobson IM, McHutchison JG, Dusheiko G, Di Bisceglie AM, Reddy KR, Bzowej NH et al. (2011). "Telaprevir for previously untreated chronic hepatitis C virus infection.". N Engl J Med 364 (25): 2405-16. DOI:10.1056/NEJMoa1012912. PMID 21696307. Research Blogging.
  8. 8.0 8.1 8.2 Poordad F, McCone J, Bacon BR, Bruno S, Manns MP, Sulkowski MS et al. (2011). "Boceprevir for untreated chronic HCV genotype 1 infection.". N Engl J Med 364 (13): 1195-206. DOI:10.1056/NEJMoa1010494. PMID 21449783. Research Blogging.
  9. 9.0 9.1 9.2 Bacon BR, Gordon SC, Lawitz E, Marcellin P, Vierling JM, Zeuzem S et al. (2011). "Boceprevir for previously treated chronic HCV genotype 1 infection.". N Engl J Med 364 (13): 1207-17. DOI:10.1056/NEJMoa1009482. PMID 21449784. Research Blogging.
  10. 10.0 10.1 Lok AS, Gardiner DF, Lawitz E, Martorell C, Everson GT, Ghalib R et al. (2012). "Preliminary study of two antiviral agents for hepatitis C genotype 1.". N Engl J Med 366 (3): 216-24. DOI:10.1056/NEJMoa1104430. PMID 22256805. Research Blogging.
  11. 11.0 11.1 Zeuzem S, Asselah T, Angus P, Zarski JP, Larrey D, Müllhaupt B et al. (2011). "Efficacy of the protease inhibitor BI 201335, polymerase inhibitor BI 207127, and ribavirin in patients with chronic HCV infection.". Gastroenterology 141 (6): 2047-55; quiz e14. DOI:10.1053/j.gastro.2011.08.051. PMID 21925126. Research Blogging.
  12. Centers for Disease Control and Prevention (2012) CDC Announces First Ever National Hepatitis Testing Day and Proposes that All Baby Boomers Be Tested Once for Hepatitis C