Hepatitis C Virus Infection

Acute hepatitis C virus (HCV) infection, defined as the first 6 months post-exposure, is often asymptomatic, particularly in high-risk groups such as injection drug users and HIV-positive men who have sex with men, with icteric presentations more commonly associated with spontaneous viral clearance. Chronic HCV infection, a heterogeneous condition resulting from prolonged viremia, can lead to severe complications including cirrhosis and hepatocellular carcinoma over decades. Although acute-on-chronic liver failure (ACLF) due to acute HCV is rare, rising global incidence of acute HCV is linked to the opioid epidemic. Unlike chronic hepatitis B, no significant clinical reactivation occurs in chronic HCV patients undergoing chemotherapy, though hepatic flares may occur in up to 23% of cases. Direct-acting antiviral (DAA) therapy, particularly sofosbuvir-based regimens with NS5a inhibitors, is recommended for acute HCV, although evidence in ACLF remains lacking.