Diagnosis of hepatitis C in the acute phase of infection

The majority of hepatitis C virus (HCV) transmissions are asymptomatic, and most people are diagnosed on routine antibody screening rather than during the acute phase of infection. However, occasionally patients may present with an acute rise in liver transaminases, jaundice, or detection of HCV RNA after a known exposure (eg needlestick injury). In this ‘acute’ setting, approximately 25% of people spontaneously clear HCV, becoming HCV RNA negative on subsequent repeat testing—this is why it is important to confirm current infection in all seropositive individuals by testing for positive HCV RNA. Factors such as female sex, young age and jaundice are associated with higher rates of clearance, but it is difficult to predict on an individual basis. It is important to consider treating all patients with detectable HCV RNA immediately if there are risk factors for transmission, especially in people who inject drugs.