Hepatitis C Management
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Direct answer
Direct-acting antivirals cure more than 95 percent of chronic hepatitis C in 8-12 weeks of all-oral therapy, and India's National Viral Hepatitis Control Programme has provided testing and treatment free of cost since 2018. Screening starts with anti-HCV antibody; a positive antibody needs HCV RNA to confirm active infection. The workhorse regimens are sofosbuvir-based — the programme commonly uses sofosbuvir 400 mg with daclatasvir 60 mg daily for 12 weeks, while pan-genotypic sofosbuvir-velpatasvir or glecaprevir-pibrentasvir (eight weeks) serve where available. Check genotype (genotype 3 dominates in India and is the hardest to cure), assess fibrosis and cirrhosis, avoid ribavirin unless specific high-risk situations demand it, and confirm cure with an undetectable RNA at 12 weeks after finishing therapy.
What you must remember
- Two-step diagnosis: anti-HCV antibody is the screen; HCV RNA is the confirmation — antibody positivity alone may reflect resolved infection, and RNA-negative patients are not treated.
- Regimens to quote: sofosbuvir 400 mg plus daclatasvir 60 mg daily for 12 weeks (the programme staple), sofosbuvir-velpatasvir 12 weeks, or glecaprevir-pibrentasvir 8 weeks for pan-genotypic cover.
- Genotype matters less now, but India's genotype 3 is the most therapy-resistant genotype and drives decompensated-cirrhosis decisions, where protease inhibitors (glecaprevir, in cirrhosis) are avoided.
- Fibrosis staging: aspartate aminotransferase-to-platelet ratio index (APRI) or fibrosis scan decides who needs cirrhosis-grade care; direct-acting antivirals work even in decompensated disease, but ribavirin is added and protease inhibitors are dropped.
- Sustained virological response: undetectable HCV RNA at 12 weeks after therapy ends equals cure; retreatment with sofosbuvir-velpatasvir-voxilaprevir rescues failures.
- Who to screen: injecting drug users, thalassaemics and haemophiliacs transfused before screening era, persons with HIV, dialysis patients, inmates, and anyone with raised transaminases or unexplained cirrhosis.
- Reinfection is real: risk behaviour must be addressed, because curing the liver does not cure the habit; antibody stays positive for life and only RNA proves activity.
- Programme anchor: the National Viral Hepatitis Control Programme (2018) targets elimination by 2030 through free testing, treatment and district-level treatment centres — a favourite community-medicine crossover point.
How to work through a treatment pathway
A 34-year-old man with a history of injecting drug use is found anti-HCV positive at a camp. The confirmatory HCV RNA returns at 2 million IU/mL, genotype 3, with normal transaminases and an APRI under one — chronic infection, no cirrhosis. Under the programme he receives sofosbuvir plus daclatasvir daily for 12 weeks; he is counselled that pills must not be missed, that no interferon injections exist anymore, and that a single blood test twelve weeks after the last tablet will pronounce him cured.
His older brother, screened next, turns out to have palpable splenomegaly and thrombocytopenia — probable cirrhosis. His pathway differs: fibrosis assessment with ultrasound and endoscopy for varices, hepatocellular carcinoma surveillance every six months regardless of cure, and a decompensated-liver regimen that avoids protease inhibitors, possibly adding weight-based ribavirin with the joy of its anaemia monitoring. And because the first patient's veins carry more than one risk, he is offered opioid substitution, testing for HIV and hepatitis B, and vaccination against hepatitis A and B — a reminder that the antiviral prescription is only half of hepatitis C care.
How the FMGE frames it
The examiner's cleanest discriminator is antibody versus RNA: stems deliberately state "anti-HCV positive" and offer "start sofosbuvir" as a distractor — the keyed answer is to confirm with RNA. Cure is defined at 12 weeks post-treatment (sustained virological response), a number NBE quotes directly. Interferon-era facts still surface as historical options, and the ribavirin-anaemia link remains a pharmacology favourite. The Indian layer is programme-based: free therapy under the National Viral Hepatitis Control Programme, genotype 3 predominance, and screening-indication lists — FMGE increasingly frames one option as the "public-health correct" answer, and this topic rewards whoever knows the 2018 programme and its 2030 elimination goal. Expect paediatric-adjacent questions too: treatment is generally from three years of age with approved weight-based regimens.
Frequently asked questions
What test confirms active hepatitis C infection after a positive antibody?
HCV RNA (viral load); antibody positivity alone may represent a spontaneously cleared past infection.
What is the standard 12-week regimen offered under India's national programme?
Sofosbuvir 400 mg plus daclatasvir 60 mg once daily for 12 weeks, provided free of cost through the National Viral Hepatitis Control Programme.
How is a cure defined after direct-acting antiviral therapy?
Sustained virological response — undetectable HCV RNA at 12 weeks after completing treatment.
Why does genotype still matter in India?
Genotype 3, the predominant Indian genotype, is the most difficult to cure and drives regimen and duration choices, particularly with cirrhosis.
Which groups warrant targeted hepatitis C screening?
People who inject drugs, transfusion-dependent patients, persons with HIV, dialysis patients and those with unexplained chronic liver disease or raised transaminases.