Hepatitis C, een ontwakende reus

– Cloning of the hepatitis C virus (HCV) was reported in 1989. By now, the entire viral genome has been sequenced. It consists of a single-stranded positive RNA, with relationship to the Flaviviridae. The envelope region shows considerable variability. 6 major genotypes have been described. HCV is transmitted via the parenteral route, mainly blood, rarely by sexual contact. Hepatitis C occurs worldwide and is found in 0.01 to 1.5 of blood donors. The immune response is unable to clear the virus in 80 of infected subjects, probably because of the hypervariability. In the acute phase the hepatitis has only mild symptoms and the chronic hepatitis usually also runs a mild course. After many years liver cirrhosis may develop in 20 of cases; in these subjects there is a high incidence of hepatocellular carcinoma. The diagnosis can be made by detection of anti-HCV antibodies in the blood and an immunoblot confirmation test. The viral genome can be detected by the HCV-RNA (PCR) test. Immunisation against patitis C is not possible yet. Therapy with interferon results in an initial response in 45 and a sustained response in < 20 of the patients. Interferon therapy reduces the incidence of hepatocellular carcinoma.