Gastrointestinal

Hepatitis C

ہیپاٹائٹس سی

Blood-borne viral infection causing chronic liver disease. Pakistan has one of the highest burdens worldwide (genotype 3 most common), and modern oral antivirals cure over 95% of patients.

ICD-10: B18.2
Source: General reference written by the assistant (not from the OPD book); needs clinical review
Status: Draft

Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.

Symptoms

Often no symptoms for years
Fatigue
Right upper abdominal discomfort
Jaundice in advanced disease
Swollen abdomen, leg swelling, bleeding in cirrhosis

Red flags Refer urgently if any are present

Vomiting blood or black stools
Confusion or drowsiness (encephalopathy)
Swollen abdomen with fever
Jaundice with decompensation

Diagnosis

Anti-HCV antibody screening
HCV RNA (PCR) to confirm active infection and viral load
Genotype is optional with pan-genotypic regimens
Assess fibrosis: FIB-4/APRI, elastography; ultrasound
Check HBV (HBsAg), HIV, creatinine, CBC, INR, albumin

Treatment

Step 1 of 5

Screen and confirm

Test anyone with risk factors: past injections or transfusions, dental or surgical procedures, shared razors, healthcare workers
Confirm with HCV RNA before treatment
Counsel on transmission (not by casual contact)

Step 2 of 5

Pre-treatment assessment

Stage the liver disease: non-cirrhotic vs compensated vs decompensated cirrhosis
Check HBV status first: HBV-HCV co-infection needs HBV monitoring or prophylaxis
Review all medicines for interactions (amiodarone with sofosbuvir is dangerous)
Decompensated cirrhosis or prior treatment failure: refer to a hepatologist

Step 3 of 5

Antiviral treatment

Direct-acting antivirals (DAAs).

Sofosbuvir + daclatasvir once daily for 12 weeks (no cirrhosis or compensated cirrhosis); 24 weeks in some cirrhosis or treatment-experienced patients, per specialist
Decompensated cirrhosis: specialist-supervised regimen, often with ribavirin
Counsel on adherence; do not stop early

Prescription

SofosbuvirDirect-acting antiviral (NS5B inhibitor)

Dose400 mg once daily

Brands Sovaldi 12 weeks (24 weeks in selected cases)

Several DRAP-registered generics are widely available and also supplied free through provincial hepatitis control programmes.

Caution: Interaction with amiodarone (serious bradycardia); Check HBV status first; reactivation risk

DaclatasvirDirect-acting antiviral (NS5A inhibitor)

Dose60 mg once daily

Brands Daklinza 12 weeks (24 weeks in selected cases)

Caution: Dose adjustment with strong CYP3A inducers/inhibitors

Step 4 of 5

Confirm cure

Repeat HCV RNA 12 weeks after treatment ends (SVR12)
Cure means undetectable HCV RNA at SVR12
Cirrhosis: lifelong ultrasound surveillance for liver cancer (every 6 months) and endoscopy screening for varices

Step 5 of 5

Prevent reinfection and spread

Screen and vaccinate for hepatitis A and B
Strict injection safety: auto-disable syringes, single-use only
Safe blood banks; avoid unlicensed dental, barber and injection practitioners

Prevention

Safe injection practice and sterilised equipment
Screened blood transfusions
Harm reduction for people who inject drugs
Hepatitis B vaccination (EPI) protects against co-infection

Guideline sources

WHO guidelines for the care and treatment of persons with chronic hepatitis C
Pakistan Society for the Study of Liver Diseases (PSSLD) guidelines
National and provincial hepatitis control programmes