Despite the availability of effective direct-acting antivirals and global goals to eliminate the hepatitis C virus (HCV) by 2030, only 52% of infected individuals in the United States are aware of their condition, and just 37% have received treatment. Barriers include the asymptomatic nature of chronic HCV, limited access to care, cost, insurance restrictions, and stigma. Universal screening is now recommended for adults 18 to 79, pregnant individuals, and those with ongoing risk. Confirmatory RNA testing follows a positive antibody result. Acute infections are often asymptomatic, and 15% to 45% of patients spontaneously clear the virus.

DAA regimens like glecaprevir/pibrentasvir and sofosbuvir/velpatasvir offer high cure rates with shorter, simpler treatment, including for patients with compensated cirrhosis. Pretreatment assessment should evaluate liver fibrosis, comorbidities, drug interactions, and vaccination needs. Most uncomplicated cases can be managed in primary care, helping expand access to treatment. Patients with cirrhosis require long-term surveillance for liver cancer and related complications. Posttreatment care should include harm-reduction counseling, lifestyle modifications, and periodic RNA testing for those at continued risk. A sustained virologic response—undetectable HCV RNA 12 weeks after treatment—indicates a cure and is linked to better overall health and quality of life.

Reference: Maness DL, Riley E, Studebaker G. Hepatitis C: Diagnosis and Management. Am Fam Physician. 2021;104(6):626-635.