Liver & intrahepatic bile ducts

Viral hepatitis

Hepatitis C virus (HCV)

Last author update: 1 May 2012
Last staff update: 22 September 2020

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PubMed Search: Hepatitis C virus[TI] HCV[TI] liver[TI]

Komal Arora, M.D.
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Cite this page: Arora K. Hepatitis C virus (HCV). website. Accessed June 10th, 2023.
Definition / general
  • 0.2% incidence in US, 170 million people infected worldwide
  • 90% of non-A, non-B hepatitis cases, 75 - 95% of transfusion associated hepatitis cases are due to hepatitis C
Causes and complications
  • 35% IV drug abuse, 15% household contact or heterosexual exposure, 5% blood transfusion, 45% unknown
  • 50 - 80% develop chronic liver disease, 20% of these develop cirrhosis
  • High risk for hepatocellular carcinoma, particularly with alcoholic cirrhosis (57% at 10 years)
  • Acute liver failure is rare
  • CD34+ sinusoidal endothelial cells are a risk factor for hepatocellular carcinoma in HCV associated chronic liver disease (Hum Pathol 2001;32:1363)
  • In HIV+ patients, cirrhosis more common if CD4 < 200 cells/microL (Hum Pathol 2000;31:69)
  • Complications: deterioration of liver status with cirrhosis in 20% and improvement in 10% with chronic hepatitis C; also hepatocellular carcinoma
  • Flavivirus, enveloped RNA virus
Poor prognostic factors
  • Necroinflammatory activity is associated with fibrosis progression (Hum Pathol 2001;32:904)
  • Also alcohol consumption, advanced age at the time of infection and immunocompromise
  • Longterm interferon alpha causes regression of cirrhosis in 5 - 10% (Hum Pathol 2004;35:107)
  • Interferon used in combination with ribavirin; orthotopic liver transplantation
  • 10% have stainable iron; some hepatologists use iron content and location in patient management
  • Occasionally may be due to mutation in gene for hereditary hemochromatosis (Arch Pathol Lab Med 2000;124:1632)
Post liver transplant
  • Recurrence of hepatitis C (as opposed to reinfection, which is almost universal) associated with more single cell hepatocyte necrosis (acidophil bodies), bile duct damage, lymphoid aggregates, cholestasis, fibrous septum, viral load (HCV RNA) > 1.25 million viral equivalents/ml
  • Recurrence may resemble cellular rejection
  • Serial biopsies may be necessary (Hum Pathol 2002;33:277, Arch Pathol Lab Med 2000;124:1623, Mod Pathol 2002;15:897)
  • HCV RNA levels are highest at time of active hepatocellular destruction (Mod Pathol 1999;12:1043)
Case reports
Microscopic (histologic) description
  • Predominantly sinusoidal lymphocytic infiltrate, often with lymphoid follicles that surround damaged bile ducts, often involvement of portal tracts
  • Mallory hyaline, mild and focal macrovesicular steatosis, minimal necrosis
  • Usually no / minimal plasma cells or eosinophils; may have irregular acidophil bodies
  • Lymphoid aggregates are specific for hepatitis C but only 50% sensitive
Microscopic (histologic) images

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Portal lymphocytosis

Bile duct involvement

Portal - portal fibrosis


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