Hepatitis C (HCV) Infections: Explaining Serology Patterns

Seroconversion occurs on average 8-9 weeks after exposure to antigen
H CV RNA Negative
Anti-HCV Antibody Positive2
HCV RNA Positive4
1 HCV Screen
Anti-HCV Antibody Negative
Suspected acute HCV3
HCV RNA will be positive in blood within 1-3 weeks after exposure
No risk factors; likely no HCV exposure
HCV RNA Negative
No HCV exposure

HCV cleared spontaneously or with treatment or false positive antibody test6
Acute HCV (15%) 5Chronic HCV (85%)

HCV RNA negative 12 or 24 weeks after stopping therapy (SVR12 or SVR24)
Abbreviations: SVR12: sustained virologic response after 12 weeks SVR24: sustained virologic response after 24 weeks
Hepatocellular Carcinoma
Cirrhosis

Decompensation (ascites, variceal bleeding, encephalopathy)
7 Liver Transplant
Death
Authors: Emma Boyce Sarah Lacny Reviewers: Peter B i s h ay Joesph Tropiano Yin Chan* * MD at time of publication
Notes: 1Indications for HCV screen: born between 1945-1965, ↑ALT/AST, IVDU, received blood or organ transplant before 1992, received clotting factors before 1987, HIV infected or multiple sexual partners, tattoos and piercings (especially if done in prison), dialysis patients, Egyptian background 2There is no HCV vaccine; an anti-HCV positive test result indicates exposure to the virus 3Seve re l y immunocompromised, hemodialysis, possible exposure, clinical manifestations 4Assess genotype and viral load (HCVRNA), symptoms, and potential exposures to diagnose chronic versus acute HCV 5Acute HCV infection is defined as the first 6 months following exposure 6The anti-HCV antibody does not protect against future infections 7Liver transplant recipients have an 80% chance of developing a recurrent HCV infection
Legend:
Pathophysiology
Mechanism
Sign/Symptom/Lab Finding
Complications
Published NOVEMBER 12, 2017 on www.thecalgaryguide.com