Microbiology · RNA hepatitis viruses
Hepatitis C virus !
- Virus
- Enveloped
- Exam priority: medium
A blood-borne virus. It often goes unnoticed for years while it damages the liver, but today oral antivirals cure it.
Updated 2026-11-01
Also called: HCV
At a glance
- Shape
- Spherical
- Genome
- Single-stranded, positive-sense RNA
- Envelope
- Enveloped
- Family
- Flaviviridae, genus Hepacivirus
- Size
- About 50 to 60 nm
Morphology
- Enveloped virus with glycoproteins E1 and E2
- Seven genotypes and dozens of subtypes; the E2 hypervariable region keeps changing
Transmission
- Blood: shared needles, unsafe injections or procedures, unscreened transfusions
- Less often: sexual (more with HIV or practices with bleeding) and mother to child
- Not spread by breast milk, food or casual contact
Reservoir: Humans
Isolation precautions
What the care team adds to standard precautions.
- Standard
Virulence factors
- An error-prone polymerase produces quasispecies that escape antibodies
- Chronic inflammation leads to fibrosis, cirrhosis and hepatocellular carcinoma
- B-cell activation: mixed cryoglobulinaemia and membranoproliferative glomerulonephritis
Diseases it causes
- Acute hepatitis C (usually silent) and chronic hepatitis C Viral hepatitis →
- Cirrhosis after years of chronic infection Cirrhosis →
- Hepatocellular carcinoma, mostly in a cirrhotic liver Hepatocellular carcinoma →
Clinical picture
- Acute infection is usually silent
- About 70% of those infected remain chronically infected
- Extrahepatic features: cryoglobulinaemia, porphyria cutanea tarda, glomerulonephritis, non-Hodgkin lymphoma, diabetes
- Past infection does not protect against reinfection
Diagnosis
- Screen with anti-HCV antibody
- If positive, HCV RNA confirms active infection (the antibody persists after cure)
- Assess fibrosis with elastography or serum scores
- RNA is detectable 1 to 2 weeks after exposure
Treatment
Oral pan-genotypic direct-acting antivirals: NS5B polymerase inhibitors (sofosbuvir), NS5A inhibitors (velpatasvir, pibrentasvir) and NS3/4A protease inhibitors (glecaprevir). They cure more than 95% of cases; interferon is no longer used.
Drug class only; doses and regimens are set by the clinician from the current guideline.
In Pharmacology:
Prevention
- Screening of donated blood and organs
- Safe injections and sterilized equipment
- Harm-reduction programmes for people who inject drugs
- No vaccine
Test yourself
Think of the answer, then tap the question to see it.
Why is a positive anti-HCV antibody not enough to diagnose active infection?
It persists in people who cleared the virus or were cured; active infection is confirmed with HCV RNA.
Which extrahepatic manifestation is classic for hepatitis C?
Mixed cryoglobulinaemia, with purpura, arthralgia and membranoproliferative glomerulonephritis.
Which viral targets do direct-acting antivirals hit?
The NS5B polymerase, the NS5A protein and the NS3/4A protease.
Why is there no hepatitis C vaccine?
Its great genetic variability, especially in glycoprotein E2, lets it escape antibodies.
Related
Related conditions
← Back to the group: RNA hepatitis viruses
Educational content on microorganisms; not a treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Hepatitis C (World Health Organization (WHO), 2025); Clinical Overview of Hepatitis C (CDC, 2025); Appendix A: Type and Duration of Precautions Recommended for Selected Infections and Conditions (CDC, 2024).
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Representative model, for educational purposes only.