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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Hepatitis C diagnosis and curative therapy

Gastroenterology and hepatology · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

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Escalate

HCV is usually treated electively, but jaundice with coagulopathy, encephalopathy, variceal bleeding, tense ascites, sepsis or acute kidney injury requires urgent hospital and liver-service care. A patient with decompensated cirrhosis must not receive a protease-inhibitor-containing regimen such as glecaprevir without specialist assessment because hepatic exposure and harm increase. Severe bradycardia can occur with some sofosbuvir-containing regimens and amiodarone; new syncope or profound bradycardia during treatment needs emergency review.

Synopsis

Confirm active hepatitis C after antibody screening, stage liver and interaction risk, deliver curative direct-acting antivirals, and prevent reinfection and missed post-cure surveillance.

  • Anti-HCV indicates exposure, not necessarily current infection; confirm active viraemia with HCV RNA or an accepted core-antigen pathway.
  • Antibody commonly remains positive after spontaneous clearance or cure, so it cannot diagnose relapse, reinfection or sustained virological response.
  • A negative antibody result can miss very recent infection or infection in severe immunosuppression; request RNA when clinical risk persists.
  • Before treatment, stage fibrosis or cirrhosis and assess decompensation, renal function, HBV and HIV status, pregnancy possibility and the complete medicine list.
  • Modern oral direct-acting antiviral combinations cure more than 95% of treated people, commonly after an eight- to twelve-week specialist-selected course.
  • Use an interaction checker and current SmPC because acid suppression, anticonvulsants, rifamycins, statins, anticoagulants and herbal products can alter safety or efficacy.
  • Sustained virological response is an undetectable RNA result at the protocol-defined post-treatment point, usually twelve weeks after completion.
  • Cure does not confer immunity; provide harm-reduction support and repeat RNA testing for ongoing exposure, while continuing HCC surveillance after cirrhosis.

    • Key red flags

    Decompensated cirrhosis

    Ascites, encephalopathy, jaundice or variceal bleeding demands transplant-linked specialist care and excludes protease-inhibitor treatment without relying on a compensated-looking clinic letter.

    Investigation priorities

    01
    Anti-HCV antibodyFirst step

    Screen for previous or current exposure to hepatitis C virus.

    Management branches

    ConfirmTurn screening into diagnosis

    Anti-HCV is reactive, exposure was recent, or immunosuppression makes antibody testing unreliable.

    1. Arrange reflex or prompt HCV RNA, explain that antibody alone does not mean current infection, and repeat RNA when timing or fluctuating early viraemia leaves uncertainty.
    2. If RNA is detectable, notify and refer through the local HCV operational pathway while assessing urgent liver failure or decompensation and offering partner or contact advice proportionately.
    3. If RNA is undetectable, distinguish prior cure or spontaneous clearance from very recent exposure and agree whether repeat RNA is required by ongoing risk.

    Key medicines

    Glecaprevir 100 mg with pibrentasvir 40 mg tabletsAdults take three tablets together once daily with food when this specialist-selected regimen is appropriate; treatment duration depends on cirrhosis, previous therapy and the current commissioned pathway.Do not use in severe hepatic impairment and it is not recommended in moderate hepatic impairment; identify any prior decompensation. Check strong transporter or enzyme interactions, statins, anticonvulsants, rifamycins, HIV medicines and ethinylestradiol-containing products against the current SmPC.
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    Sources and review status6 sources · checked 27 Aug 2026 · clinical review pending+
    Sources

    Sources and review status

    National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

    • UKHSA hepatitis C information for GPsOfficial UK testing sequence, antibody window, RNA confirmation and re-engagement advice.
    • NICE TA499 glecaprevir and pibrentasvirNational recommendation for the pangenotypic DAA combination in chronic hepatitis C.
    • Glecaprevir and pibrentasvir Summary of Product CharacteristicsCurrent UK dose, hepatic restrictions, interactions, pregnancy and adverse-effect information.
    • NHS England hepatitis C treatment milestoneCurrent NHS treatment access, typical course length and real-world cure proportion.
    • UKHSA hepatitis C surveillance collectionCurrent national epidemiology, prevention, testing and elimination programme reports.
    • NICE NG50 cirrhosis assessment and managementSix-monthly HCC surveillance and continuing specialist complication care for people with established cirrhosis, including after the causal liver injury has been treated.

    Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

    Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom