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Clinical manifestations, diagnosis, and treatment of acute hepatitis C in adults

INTRODUCTION

By convention, acute hepatitis C virus (HCV) infection refers to the presence of clinical signs or symptoms of hepatitis within six months of presumed HCV exposure [1]. While acute hepatitis C virus (HCV) infection is estimated to account for 15 percent of symptomatic cases of acute liver disease in the United States, the majority of patients with acute HCV go undetected [2,3]. This is due in large part to the fact that patients with acute HCV are typically asymptomatic. In the United States, the Centers for Disease Control and Prevention estimated that there were 16,500 new cases of HCV in 2011, of which only 1.229 cases were reported [4]. If acute HCV is diagnosed (either because of symptoms or screening high-risk patients), early treatment is appropriate for patients who do not spontaneously clear the virus, and is associated with high sustained virologic response rates. (See 'Treatment' below.)

This topic will review acute HCV in adults. Issues related to the transmission of HCV, screening for HCV, and managing patients with chronic HCV are discussed elsewhere. (See "Epidemiology and transmission of hepatitis C virus infection" and "Clinical manifestations and natural history of chronic hepatitis C virus infection" and "Screening for chronic hepatitis C virus infection" and "Overview of the management of chronic hepatitis C virus infection" and "Diagnosis and evaluation of chronic hepatitis C virus infection".)

CLINICAL MANIFESTATIONS

Acute hepatitis typically develops 2 to 26 weeks after exposure to hepatitis C virus (HCV), with a mean onset of 7 to 8 weeks [5]. In patients who experience symptoms, the acute illness usually lasts for 2 to 12 weeks. Symptoms may include jaundice, nausea, dark urine, and right upper quadrant pain. However, most patients who are acutely infected with HCV are asymptomatic. Patients with acute HCV typically have moderate serum aminotransferase elevations, though they may go undetected in asymptomatic patients. Fulminant hepatic failure due to acute HCV infection is very rare but may be more common in patients with underlying chronic hepatitis B virus infection [6,7]. (See "Acute liver failure in adults: Etiology, clinical manifestations, and diagnosis".)

Symptoms — While the majority of patients with acute HCV are asymptomatic, some develop symptoms of acute hepatitis. In a review that included five studies from the National Heart, Lung, and Blood Institute Study of Transfusion-Associated Non-A, Non-B, and Type C Hepatitis, more than two-thirds of patients with acute HCV were asymptomatic during the acute episode [8].

Jaundice is a common symptom reported among patients presenting with symptomatic acute HCV. In a study that included 51 patients with symptomatic acute HCV, patients reported jaundice (68 percent), dark urine and white stool (39 percent), nausea (34 percent), and abdominal pain (25 percent, predominantly right upper quadrant pain) [9]. Additional symptoms reported in other studies include fatigue, low-grade fever and chills, loss of appetite, pruritus, muscle aches, mood disturbances, joint pain, dyspepsia, and confusion [10].

                      

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Literature review current through: Nov 2014. | This topic last updated: Jul 31, 2014.
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