History and Physical Examination
The incubation period of hepatitis C virus (HCV) infection varies widely, with a mean of 7-10 weeks and a range of 2-20 weeks. Infections are often inapparent or subclinical. Only 25-35% of patients have nonspecific symptoms such as weakness, malaise, and anorexia; likewise, patients with chronic HCV infection often have few or no symptoms. Fatigue is reported most often.
Screen patients for HCV infection if any of the following applies:
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History of illegal injected drug use
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Transfusion with clotting factor concentrates before 1987
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Transfusion with blood or blood components or receipt of organ transplants before July 1992
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Use of HCV-contaminated blood from a donor
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Long-term hemodialysis or persistently abnormal serum alanine aminotransferase (ALT) levels
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Needle sticks, accidents with sharps, or mucosal exposures to HCV-positive blood
Considering HCV testing in patients with HIV infection may be prudent, especially in those who acquired HIV through intravenous drug use. HCV is more easily transmitted than HIV, and the 2 viruses are often co-infections.
Approximately 25% of patients with acute HCV infection have jaundice, whereas less than one third have hepatomegaly. Some patients with chronic infection have findings consistent with chronic liver disease; these include hepatomegaly, ascites, splenomegaly, and spider nevi.
Complications
Complications may include the following:
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Fulminant hepatitis (rare)
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Cirrhosis, which may result in portal hypertension and liver failure
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Hepatocellular carcinoma
Extrahepatic manifestations may include the following:
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Porphyria cutanea tarda
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Sialadenitis resembling Sjögren syndrome
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Mooren corneal ulcers, a form of chronic ulcerative keratitis
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Type II cryoglobulinemia
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Membranoproliferative glomerulonephritis
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Non-Hodgkin lymphoma
