Synopsis
Detect active hepatitis C with RNA testing, link every viraemic person to curative therapy, manage exposure safely, and prevent reinfection and advanced liver complications.
- HCV is blood-borne; injecting equipment is the principal UK route, while needlestick, unscreened historical blood, tattooing and sexual blood exposure also matter.
- Antibody shows exposure, not current infection. Detectable HCV RNA confirms active viraemia and is the result that triggers treatment linkage.
- A negative antibody test can miss very recent acquisition or immune suppression; request HCV RNA when clinical or exposure suspicion remains high.
Key red flags
Haematemesis, melaena, hypotension or syncope in known or possible cirrhosis requires immediate variceal-bleeding management and endoscopy planning.
Ascites, variceal bleeding, encephalopathy, jaundice and renal dysfunction signal advanced disease and constrain antiviral selection.
Investigation priorities
Screen for previous exposure in people beyond the antibody window period.
Management branches
A person has a past or current blood exposure, belongs to a higher-prevalence group or has unexplained liver disease.
- Ask non-judgementally about injecting and equipment sharing, prison, tattoos, transfusion era and country, healthcare exposure, sexual blood exposure and previous testing or treatment.
- Request anti-HCV with laboratory reflex RNA testing whenever possible, or request RNA directly if exposure is recent or antibody formation may be impaired.
Key medicines
Glecaprevir with pibrentasvirGive glecaprevir 300 mg plus pibrentasvir 120 mg orally once daily as three 100 mg/40 mg tablets with food for eight weeks in suitable treatment-naive compensated infection.
Sofosbuvir with velpatasvirGive one 400 mg/100 mg tablet orally once daily with or without food for 12 weeks in the standard specialist-selected adult regimen.