Acute hepatitis C

Disease Description (Causes and Symptoms)

• Definition: Acute hepatitis C is a disease in which the liver becomes inflamed and liver cells are damaged due to the hepatitis C virus (HCV).
• Cause/Transmission: Primarily blood-borne infection (contaminated injection needles, acupuncture needles, tattooing or piercing equipment, etc.); rarely through sexual contact (transmission through semen or vaginal fluids); in some cases, the cause is unknown. It is not readily transmitted through ordinary contact.
• Pathophysiology Summary: HCV infects liver cells, and hepatitis develops as viral replication and the host immune response occur. In some people, the virus is eliminated and they recover, but a considerable number progress to chronic infection.
• Main Symptoms: Fatigue, low-grade fever, muscle aches, nausea, vomiting, loss of appetite, abdominal discomfort, dark urine, jaundice, and itchy skin. Many patients may be asymptomatic or may mistake the illness for cold-like symptoms.

Treatment Methods and Precautions

• Diagnostic Tests: Anti-HCV (antibody) testing is performed as a screening test; if positive, the diagnosis is confirmed with an HCV RNA test (presence and quantification of the virus). Follow-up observation is conducted until approximately 12 weeks (about 3 months) after onset, and HCV RNA testing at 4 and 6 months may be performed if necessary.
• Antiviral Treatment:
  • Since most people may recover spontaneously during the acute phase, rather than treating immediately, persistent infection is assessed with HCV RNA, usually at 8–12 weeks. Direct-acting antivirals (DAAs) are administered when there is a risk of progression to chronic infection or persistent viremia is confirmed.
  • The current standard is oral combination DAA therapy (e.g., sofosbuvir/velpatasvir, glecaprevir/pibrentasvir, etc.), and the cure rate (sustained virologic response) for chronic HCV is over 90%. The timing of treatment initiation and choice of medication for acute infection are determined based on the patient’s condition, genotype, and underlying diseases.
  • Interferon-based treatments used in the past have now largely been replaced by DAAs.
• Supportive Treatment and Lifestyle Management: Absolute bed rest is not necessary, but sufficient rest and nutrition (a high-protein, balanced diet) are recommended, along with prevention of dehydration. Avoid alcohol (which increases hepatotoxicity) and hepatotoxic medications (including some analgesics and supplements).
• Vaccination: Check vaccination status for hepatitis A and B, and vaccination is recommended for those who have not been vaccinated (to prevent coexisting liver disease).
• Precautions/Complications: Acute liver failure is rare but possible. The biggest concern is that approximately 50% of cases progress to chronic hepatitis C, increasing the long-term risk of cirrhosis and hepatocellular carcinoma. Drug interactions and adverse effects (such as fatigue and headache) should be checked during treatment.

Checklist Before an Outpatient Visit (Including Items to Bring and Sample Questions)

• Items to Bring/Things to Check in Advance:
  • A list of all medications, nutritional supplements, and herbal medicines currently being taken (including dosage and duration of use)
  • Copies or records of previous test results (prior Anti-HCV, HCV RNA, liver function tests [AST/ALT], ultrasound examinations, etc.)
  • A record of when recent symptoms began and how they have changed (jaundice, changes in urine color, fatigue, etc.)
  • Risk factors, including a history of recent blood transfusions, injections, tattoos, invasive procedures, sexual exposure, and injection drug use
  • Possibility of pregnancy (for women) and whether you are breastfeeding
  • Vaccination history (hepatitis A/B)
• Items Worth Recording for the Outpatient Visit:
  • Alcohol consumption over the past 3 months, weight changes, and history of allergies
  • Family history (liver disease and liver cancer)
• Test Preparation: Blood tests (liver function, blood cell counts, coagulation, etc.), Anti-HCV and HCV RNA (quantitative), and liver ultrasound if necessary

Examples of General Questions to Ask a Doctor

• What are the expected effects and possible side effects of this medication (or treatment)?
• When is the appropriate time to start treatment in my case? Do you recommend starting treatment immediately, or starting after a period of observation?
• How long will the treatment last, and how will cure (elimination of the virus) be confirmed?
• What precautions should I take in daily life during treatment (regarding alcohol consumption, driving, going to work, etc.)?
• Do I need to inform people I live with or my sexual partner? What preventive measures should be taken?

Examples of Disease-Specific Questions

• Based on my quantitative HCV RNA test result, when will I start antiviral treatment? (For example, ask about the test value threshold and observation period.)
• If I am currently taking any medications (or supplements), could you check whether they interact with the planned DAA?

(Note: Decisions regarding diagnosis and treatment are ultimately made by the treating doctor after considering the individual patient’s condition, viral genotype, underlying liver condition, and comorbidities.)