[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Microbiology](https://durgical.com/en/microbiology/) › [RNA hepatitis viruses](https://durgical.com/en/microbiology/groups/rna-hepatitis-viruses/) › Hepatitis C virus

[Microbiology](https://durgical.com/en/microbiology/) · [RNA hepatitis viruses](https://durgical.com/en/microbiology/groups/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

## Key points

- Blood-borne flavivirus (Hepacivirus)
- Most infections become chronic: cirrhosis and hepatocellular carcinoma
- Antibody to screen, RNA to confirm
- Mixed cryoglobulinaemia is the classic extrahepatic feature
- Direct-acting antivirals cure over 95%; no vaccine

## 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 →](https://durgical.com/en/conditions/viral-hepatitis/)
- Cirrhosis after years of chronic infection [Cirrhosis →](https://durgical.com/en/conditions/cirrhosis/)
- Hepatocellular carcinoma, mostly in a cirrhotic liver [Hepatocellular carcinoma →](https://durgical.com/en/conditions/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:

- [Sofosbuvir](https://durgical.com/en/pharmacology/sofosbuvir/)

## Prevention

- Screening of donated blood and organs
- Safe injections and sterilized equipment
- Harm-reduction programmes for people who inject drugs
- No vaccine

## In Colombia

Hepatitis C is notifiable to SIVIGILA. Colombia follows the WHO goal of eliminating viral hepatitis as a public health problem, through screening and access to direct-acting antivirals.

## Memory aid

C is for "Chronic" and "Curable": it stays silent for years, but today it can be erased.

## 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.

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## Related

- [Hepatitis D virus](https://durgical.com/en/microbiology/hepatitis-d-virus/)
- [Human immunodeficiency virus](https://durgical.com/en/microbiology/human-immunodeficiency-virus/)

## Related conditions

- [Viral hepatitis](https://durgical.com/en/conditions/viral-hepatitis/)
- [Cirrhosis](https://durgical.com/en/conditions/cirrhosis/)
- [Hepatocellular carcinoma](https://durgical.com/en/conditions/hepatocellular-carcinoma/)

## What the colours mean

**Gram-positive**
Thick peptidoglycan wall: stains purple.

**Gram-negative**
Thin wall with an outer membrane: stains pink.

**Acid-fast**
Lipid-rich wall (mycobacteria): Ziehl–Neelsen stain.

[← Back to the group: RNA hepatitis viruses](https://durgical.com/en/microbiology/groups/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](https://www.who.int/news-room/fact-sheets/detail/hepatitis-c) (World Health Organization (WHO), 2025); [Clinical Overview of Hepatitis C](https://www.cdc.gov/hepatitis-c/hcp/clinical-overview/index.html) (CDC, 2025); [Appendix A: Type and Duration of Precautions Recommended for Selected Infections and Conditions](https://www.cdc.gov/infection-control/hcp/isolation-precautions/appendix-a-type-duration.html) (CDC, 2024).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

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