Chronic hepatitis C

1) Disease Description (Causes and Symptoms)

• Definition summary: Chronic hepatitis C is a condition in which infection with the hepatitis C virus (HCV) persists for 6 months or longer, HCV RNA is positive, and chronic inflammation is present in the liver.
• Causes/transmission: Primarily blood-borne transmission (contaminated needles, medical, tattooing, or piercing equipment, past blood transfusions, etc.). Vertical transmission (mother-to-child) and sexual contact occur rarely. There is no vaccine.
• Pathophysiology: Persistent HCV infection of liver cells causes chronic inflammation, and in some cases progresses to fibrosis, cirrhosis, and hepatocellular carcinoma.
• Main symptoms: Most people have no symptoms. Fatigue, indigestion, upper abdominal discomfort, and jaundice may occur.

2) Treatment Methods and Precautions

• Standard treatment: Treatment with direct-acting antivirals (DAAs, oral medications) for 8–16 weeks (usually 8–12 weeks). The treatment rate (SVR, undetectable virus 12 weeks after treatment) reaches >90%.
  • Frequently used medications (examples):
    • Sofosbuvir/velpatasvir (pangenotypic, usually 12 weeks)
    • Glecaprevir/pibrentasvir (pangenotypic, 8 weeks for non-cirrhotic patients, etc.)
    • Sofosbuvir/ledipasvir (primarily genotype 1)
  • The choice and duration of medication are determined by the HCV genotype, presence or absence of cirrhosis, previous treatment history, kidney function, and other factors.
• Monitoring/tests: HCV RNA before, during, and after treatment; liver function tests (ALT/AST); kidney function tests; and review of drug interactions. Confirmation of SVR12 (negative HCV RNA 12 weeks after the end of treatment) is the measure of cure.
• Risk of complications and prognosis: If untreated or if treatment fails, approximately 20–30% of patients may progress to cirrhosis within several years, and the risk of hepatocellular carcinoma (HCC) increases when cirrhosis develops. Patients with cirrhosis need HCC surveillance (such as ultrasound every 6 months) even after achieving a cure (SVR).
• Precautions/contraindications and interactions:
  • Some DAAs interact with strong CYP or P-gp inducers (e.g., some anticonvulsants and rifampin are contraindicated).
  • Severe bradycardia has been reported with concomitant use of sofosbuvir-based medications and amiodarone — concomitant use is contraindicated or requires strict monitoring.
  • Limiting alcohol consumption is recommended during and after treatment (due to the risk of worsening liver damage).
  • Checking immunity to hepatitis A and B is recommended (vaccination is recommended if not immune). Be aware of the risk of HBV reactivation in cases of coinfection with hepatitis B.
• Lifestyle management: Avoid or minimize alcohol, use caution with hepatotoxic medications (some pain relievers and supplements), maintain personal hygiene (do not share razors, toothbrushes, or needles), and practice safe sex (avoid sexual activities involving bleeding).

3) Checklist Before an Outpatient Visit (Including What to Prepare and Example Questions)

• Items/information to bring:
  • A list of all medications and supplements currently being taken (including prescription and nonprescription drugs and herbal medicines)
  • Previous test results (previous HCV antibody, HCV RNA, liver function, and imaging results)
  • Vaccination records (especially for hepatitis A and B)
  • Amounts of alcohol and drug use and sexual history (answer medical staff’s questions truthfully)
  • For women, whether pregnancy is possible and recent test results (a pregnancy test may be needed)
• Tests/evaluations that may be needed:
  • Anti-HCV (antibody), quantitative HCV RNA (baseline and after treatment), HCV genotype (if needed), liver panel (ALT/AST/total bilirubin/albumin/INR), kidney function, HBV/HIV tests, FibroScan (fibrosis assessment), or liver ultrasound
• Symptom changes that are useful to record for the outpatient visit: degree of fatigue, jaundice, indigestion, weight changes, abdominal pain, and whether bleeding or swelling is present

4) Examples of General Questions to Ask the Doctor

• "What is the expected success rate (SVR) of this treatment?"
• "What are the main side effects of this medication, and how should I respond if they occur?"
• "What additional tests or follow-up care will I need during or after treatment?"
• "Do I need surveillance for liver cancer (hepatocellular carcinoma)?"
• "Which vaccinations (hepatitis A and B) do I need?"

5) Examples of Disease-Specific Questions

• (General patient with chronic hepatitis C) "Based on my HCV genotype and fibrosis (or FibroScan) results, which medication and treatment duration do you recommend?"
• (Patient with cirrhosis) "Even if I achieve a cure (SVR), how long and by what methods should I undergo HCC surveillance because I have cirrhosis?"

Additional information: The attending physician determines the treatment plan and medication selection based on accurate test results (quantitative HCV RNA, genotype, degree of liver fibrosis, coinfections and underlying diseases, medications being taken, etc.). If you have questions or suspect a drug interaction, be sure to consult a doctor before treatment.