Fatigue in chronic viral hepatitis may be associated with decreased health-related quality of life and other patient-reported outcomes (PROs). We evaluated the relationship between fatigue and PROs in patients with chronic hepatitis B (CHB) and chronic hepatitis C (CHC). Patients with CHB and CHC enrolled in the Global Liver Registry completed PRO instruments: FACIT-F, CLDQ (for CHB), CLDQ-HCV (for CHC), and WPAI:SHP. Fatigue was defined as FACIT-F Fatigue Scale (FS) score < 30 (scale range: 0-52). Among 2888 patients from 14 countries, 1561 had CHB (mean age 47 ± 13 years; 60% male; 13% advanced fibrosis; 13% depression; 17% fatigue) and 1327 had CHC (50 ± 13 years; 47% male; 21% advanced fibrosis; 18% depression; 28% fatigue). CHB-fatigue was associated with younger age, female, obesity, anxiety, depression (all p < 0.01) and worse PRO scores: CLDQ (scale 1-7): 4.1 ± 0.9 vs. 5.8 ± 0.9; FACIT score (range 0-108): 67.6 ± 14.5 vs. 87.7 ± 13.7; work productivity impairment (range 0-1): 0.33 ± 0.29 vs. 0.11 ± 0.22 (all p < 0.0001). Multivariable analysis confirmed the association of fatigue with lower PRO scores, impairment up to -23% (p < 0.01). CHC-fatigue was associated with female sex, obesity, type 2 diabetes, anxiety, depression (all p < 0.05) and worse PRO scores: CLDQ-HCV: 3.8 ± 1.0 vs. 5.5 ± 1.0; FACIT: 61.8 ± 14.1 vs. 85.6 ± 14.5; work productivity impairment: 0.49 ± 0.32 vs. 0.17 ± 0.25 (all p < 0.0001). In multivariable models, fatigue remained associated with reduced PRO scores, impairment up to -33% (p < 0.01). Almost one in five patients with chronic viral hepatitis report significant fatigue, which is associated with substantial PRO and work productivity impairment. Routine assessment for and management of fatigue in CHC or CHB care is essential.

We investigated serum-derived extracellular vesicle (EV)-associated proteins as predictors of liver fibrosis (LF) regression following sustained virological responses (SVR) in individuals with chronic hepatitis C (CHC) managed using direct-acting antiviral (DAA) therapy. We retrospectively analyzed 107 CHC patients with pretreatment Mac-2 binding protein glycosylation isomer (M2BPGi) levels ≥ 2.0 cut-off index (COI). Two years after the end of treatment (EOT), participants were grouped according to the M2BPGi levels: regression group (M2BPGi < 1.76 COI) and non-regression group (M2BPGi ≥ 1.76 COI). Twelve patients were selected for the discovery cohort, where comprehensive protein profiling of serum-derived EVs was performed at 12-24weeks post-EOT using quantitative mass spectrometry for label-free quantification. The remaining 95 patients formed the validation group, in which the identified EV proteins were further assessed via protein quantification using parallel reaction monitoring. Reelin (RELN) and oncoprotein-induced transcript 3 (OIT3) protein had potential role as predictors of fibrosis regression in both groups. Multivariate analysis incorporating clinical parameters indicated that levels of RELN and OIT3 were associated with fibrosis regression (odds ratio [OR] = 1.510; P = 0.022 for log2 RELN, and OR = 0.297; P = 0.001 for log2 OIT3). In cases with advanced fibrosis (baseline M2BPGi ≥ 3.3 COI), RELN showed a borderline significant result (OR = 1.550; P = 0.050 for log2 RELN). Serum-derived EV levels of RELN show promise as predictor of LF regression in CHC patients following SVR.

Hepatitis C Virus Can Induce Gene Expression Changes Associated with Hepatocarcinogenesis.

Chronic hepatitis C (CHC) infection remains a global health burden, contributing to the risk of long-term complications such as progressive fibrosis, cirrhosis, and hepatocellular carcinoma, particularly in undiagnosed or untreated individuals. Novel biomarkers for the assessment of disease progression and prognosis are required for fibroinflammatory chronic liver disease. Our study population from the Hepatitis C Antiviral Long Term Treatment Against Cirrhosis (HALT-C) trial was used to investigate the association of neoepitope fibroinflammatory biomarkers with clinical outcomes in patients with CHC infection. Baseline serum samples from 339 patients with advanced CHC from the HALT-C cohort were included and assessed for liver-related clinical outcomes. We assessed the fibrogenesis marker nordicPRO-C3™ and the neutrophil activity marker nordicCPa9-HNE™. The active fibrogenesis marker PRO-C3 was associated with disease progression and liver-related outcomes in patients with CHC, with a 4-fold increased hazard (95% CI: 1.91-8.30) of liver-related outcomes in patients with high compared with low PRO-C3 levels at baseline. Grouping patients with a combination of high or low active fibrogenesis, PRO-C3, and high and low neutrophil activity, CPa9-HNE, revealed that the patient endotype with high fibrogenesis and low neutrophil activity had the highest risk of developing liver-related outcomes in patients with CHC. PRO-C3 was associated with the risk of liver-related outcomes in patients with CHC infection in our HALT-C subpopulation. Grouping patients based on neoepitope biomarkers reflecting active fibrogenesis and neutrophil activity could provide fibroinflammatory disease endotype classification that may be applicable to other chronic liver diseases with appropriate validation.

IntroductionGlecaprevir/pibrentasvir (G/P) is a pan-genotypic, interferon-free, direct-acting antiviral regimen approved for chronic hepatitis C (CHC) treatment. While clinical trials have demonstrated its efficacy and safety, real-world data in the Korean population remain limited. This post-marketing surveillance study aimed to evaluate the safety and effectiveness of G/P in Korean patients with CHC in routine clinical practice.MethodsA prospective, multicenter observational study was conducted across 56 institutions in Korea from January 2018 to January 2024. Adult and adolescent patients (aged ≥ 12 years) with CHC receiving G/P were enrolled. Safety outcomes evaluated adverse events (AEs), including serious AEs (SAEs), and treatment-related AEs. Effectiveness was assessed by sustained virologic response at 12 weeks post-treatment (SVR12) in evaluable patients.ResultsOf 3061 patients enrolled, 51.1% were female and 18.6% had cirrhosis. AEs were reported in 9.7% of patients, with pruritus (2.0%) and headache (1.0%) being most common. SAEs occurred in 1.2% of patients, and 0.3% discontinued treatment due to AEs. No new safety signals were identified. SVR12 was achieved in 98.2% of the effectiveness population (n = 2434). Among patients whose hepatitis C virus RNA was monitored during therapy, on-treatment virologic failure occurred in 1.3%, while post-treatment relapse was observed in 1.2%.ConclusionsG/P therapy demonstrated a manageable safety profile and high effectiveness in Korean patients with CHC in real-world settings, supporting its continued use and coverage under national health programs.Clinical Trials RegistrationClinicalTrials.gov (NCT03740230).Supplementary InformationThe online version contains supplementary material available at 10.1007/s40121-026-01349-w.

Genetic influence of IFN-γ gene polymorphisms on hepatitis C progression and recovery.

Glecaprevir/pibrentasvir (G/P) is globally approved for the treatment of chronic hepatitisC virus (HCV) infection and for acute HCV infection in the USA. The efficacy and safety of G/P has been clinically demonstrated in participants with chronic HCV. We used clinical trial data to assess the efficacy, safety, and tolerability of G/P in participants with comorbidities or on multiple concomitant medications with potential for drug-drug interaction with G/P. An integrated pooled analysis across 21 randomized, controlled phase2 and 3 trials of participants who received G/P for 8, 12, or 16weeks was performed. Participants were stratified by comorbidity or population of interest and by number of concomitant medications received. This analysis included 6547 participants with chronic HCV infection. Overall, 2068 (31.6%) had cardiovascular disorders, 2031 (31.0%) reported illicit drug use, 1373/4617 (29.7%) reported injection drug use, 1810 (27.6%) had psychiatric disorders, 1169 (17.9%) had compensated cirrhosis, and 291 (4.4%) had human immunodeficiency virus (HIV)-HCV coinfection. Additionally, 4524 (69.1%) were receiving ≥ 1 concomitant medication. According to the Liverpool HEP Drug Interactions checker, 1357 (20.7%) were receiving a concomitant medication with mechanistic potential or weak potential drug-drug interaction with G/P. Overall, 94.3% (6174/6547) achieved sustained virologic response at 12weeks post-treatment (SVR12: 98.7% [6174/6257] when excluding non-virologic treatment failure), with consistent rates between subgroups. In total, 3140 (48.0%) of participants experienced an adverse event (AE) and 1638 (25.0%) experienced a treatment-related AE. Serious AEs and treatment-related serious AEs were observed in 165 (2.5%) and 6 (0.1%) participants, respectively. In subgroup analyses, the highest rate of treatment-related serious AEs was observed in participants with HIV-HCV coinfection (0.7%). Mean compliance was 99.6%, which was consistent across subgroups and by number of concomitant medications received. These pooled data support the efficacy, safety, and tolerability of G/P in participants with chronic HCV infection and comorbidities or who are on multiple concomitant medications.

Although ombitasvir/paritaprevir/ritonavir plus dasabuvir (OPrD) therapy is highly effective for chronic hepatitis C (CHC), clinicians frequently encounter transient hyperbilirubinemia, which can be misidentified as hepatotoxicity. This study investigated the role of SLCO1B1 (OATP1B1) and SLCO1B3 (OATP1B3) genetic polymorphisms in predicting bilirubin spikes and distinguishing transporter-mediated interference from hepatocellular injury. In this prospective study of 65 patients with HCV genotype 1, genotyping for OATP1B1 (c.388A>G, c.521T>C) and OATP1B3 (c.334T>G, c.699G>A) was performed using PCR-RFLP and capillary electrophoresis (QIAxcel Advanced System). Clinical and biochemical parameters were monitored over a 12-week treatment period. Hyperbilirubinemia (total bilirubin >1.1 mg/dL) developed in 18.5% of the cohort, typically within the first month. A distinct ‘AST-dominant’ biochemical signature, elevated bilirubin and AST paired with stable ALT, was identified, suggesting transporter-specific interference rather than hepatocyte damage. Statistical analysis pinpointed the OATP1B3 c.699G>A (rs7311358) variant as the sole genetic driver (p = 0.007). Carriers of the c.699G>A allele faced a 6.3-fold higher risk of developing hyperbilirubinemia (OR: 6.30, 95% CI: 1.48–26.80, p = 0.032), while no significant associations were found for OATP1B1 variants. We conclude that OATP1B3 c.699G>A is a potent predictor of OPrD-induced hyperbilirubinemia. Identifying this genotype pre-treatment allows clinicians to anticipate transient, benign bilirubin elevations and prevent unnecessary drug discontinuation, thereby mitigating therapeutic inertia and ensuring treatment continuity for CHC patients.

Background: Chronic viral hepatitis is a major global health problem associated with progressive liver injury and an increased risk of cirrhosis and hepatocellular carcinoma. The identification of novel biomarkers may improve disease monitoring and diagnostic accuracy. Methods: In this prospective case–control study, a total of 90 participants were included: 20 patients with chronic hepatitis B (CHB); 20 with chronic hepatitis C (CHC); 20 with HBeAg-negative chronic infection (HCI); and 30 age-, sex-, and body mass index-matched healthy controls. Serum irisin and nesfatin-1 levels were measured using enzyme-linked immunosorbent assays (ELISAs). Group comparisons were performed using multivariate analysis of variance (MANOVA) followed by Scheffé post hoc tests. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic performance. Results: Significant differences were observed among groups in terms of irisin, nesfatin-1, total bilirubin, and platelet counts (p ≤ 0.05). Nesfatin-1 levels were significantly higher in all patient groups compared with healthy controls (p < 0.001). Irisin levels were only significantly lower in the HCI group (p < 0.001). ROC analysis indicated that nesfatin-1 may have the potential to discriminate between infected patients and healthy individuals; however, the generalizability of this finding is limited by the study design and sample size. Conclusions: Nesfatin-1 may represent a potential biomarker for chronic viral hepatitis, whereas alterations in irisin levels may be more specific to the inactive carrier phase.

Impact of Cardiometabolic Risk Factors and Steatotic Liver Disease on Liver-Related Outcomes in Patients With Chronic Hepatitis C After Curative Antiviral Therapy.

ABSTRACT Background Chronic hepatitis C (CHC) remains a major public health challenge in China. Currently, direct-acting antivirals (DAAs) are the mainstay of clinical treatment. This study employed a discrete choice experiment (DCE) to investigate physicians’ preferences regarding DAAs for the treatment of CHC. Methods A DCE was designed based on the Chinese Guideline for Comprehensive Clinical Evaluation of Drugs and relevant literature, incorporating seven core attributes: safety, efficacy, economy, innovativeness, appropriateness, accessibility, and affordability. Fourteen choice sets were constructed. Physicians’ preferences were analyzed using conditional logit models, from which willingness-to-pay (WTP) and relative importance of attributes were derived. Latent class analysis (LCA) was further applied to explore heterogeneity in physicians’ preferences. Results Data were collected from 159 hospitals across 27 provinces in China, with 185 valid questionnaires included. Efficacy emerged as the most important determinant of prescribing preference, followed by affordability and economy, then accessibility, safety, and appropriateness, while innovativeness was not a significant concern. The LCA identified three distinct latent classes, which were significantly associated with demographic variables. Conclusions In China’s healthcare setting, beyond the central importance of efficacy, physicians also place great emphasis on affordability and economic value, with marked heterogeneity in preferences depending on background characteristics.

Hepatitis C virus (HCV) infection is a global health concern, chronically affecting over 71 million people. It primarily targets the liver but also causes systemic complications through inflammation, oxidative stress, and metabolic dysregulation. HCV is a highly variable RNA virus with six major genotypes that are mainly transmitted via blood. Often asymptomatic, the infection progresses silently to chronic hepatitis C (CHC), which can lead to fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). Direct-acting antivirals (DAAs) have revolutionized treatment, achieving cure rates above 95%, improving liver function, reversing fibrosis, and normalizing metabolism. HCV disrupts iron metabolism by suppressing hepcidin, causing iron overload and oxidative stress. It also alters lipid metabolism, inducing steatosis, and affects glucose metabolism, contributing to insulin resistance and type 2 diabetes. DAAs improve these metabolic outcomes. HCV promotes oxidative stress via viral proteins, damaging liver cells and DNA and triggering inflammation and fibrogenesis. Even post-cure, oxidative stress and iron overload may continue to drive disease progression. Genetic and epigenetic factors influence fibrosis progression and HCC risk. Despite a sustained virologic response (SVR), patients with advanced liver damage remain at risk for HCC and metabolic diseases, highlighting the need for continued monitoring and personalized post-treatment care.

High-normal and abnormal alanine transaminase levels linked to increased risk of hepatoma following treatment for chronic hepatitis C.

Impact of Hepatitis C screening and treatment among incarcerated populations in Alberta, Canada on population-level Hepatitis C elimination efforts.

More than 2.4 million people were estimated to have chronic hepatitis C (CHC) in the United States from 2017 to 2020. Direct-acting antiviral (DAA) therapy can cure hepatitis C and limit its complications, including liver cirrhosis and hepatocellular carcinoma (HCC). This study aims to estimate the lifetime medical cost burden of CHC in the United States. We estimated the lifetime direct medical costs of CHC by disease stage, using medical and laboratory claims data and a Markov transition model. The analysis considered the cost of CHC separately for persons treated with DAAs and untreated persons. We estimated the cost of health care utilization associated with CHC per person for the initial year, remaining life years, and overall lifetimes and used these costs to estimate lifetime costs for the 2020 cohort of adults with CHC in the United States in 2020. On average, medical costs per person in a disease stage were $89,070 (treated) and $150,669 (untreated) for non-cirrhosis, $104,961 (treated) and $197,469 (untreated) for cirrhosis, $59,120 (treated) and $208,646 (untreated) for decompensated cirrhosis, $44,876 (treated) and $113,975 (untreated) for hepatocellular carcinoma. The overall per person lifetime medical cost (weighted by the percentage of newly reported cases in each disease stage) was $90,089 (treated) and $155,930 (untreated). For a cohort of 2.228 million people, the projected total medical cost burden of CHC in 2022 dollars would be $200 billion if all were treated using DAAs, compared to $347 billion if all were untreated. We found a substantial reduction in the overall lifetime medical costs of hepatitis C for persons treated with DAAs compared to untreated persons. These potential health care savings from expanded hepatitis C treatment underscore the importance of expanding HCV testing and DAA treatment as core components of the national strategy for hepatitis C elimination.

Background/AimsThis matched case-control study investigated the impact of HFE gene mutations on sustained virological response (SVR) in Egyptian patients with chronic hepatitis C (CHC) treated with daclatasvir and sofosbuvir.MethodsA total of 150 CHC patients were enrolled (75 responders and 75 non-responders) based on HCV RNA levels 12 weeks post-treatment. HFE gene mutations (C282Y, H63D, S65C) were detected by PCR-restriction fragment length polymorphism. Liver function and iron parameters were assessed.ResultsAmong responders, 86.67% had wild-type HFE alleles, compared to 72.00% of non-responders (p = 0.027). Heterozygous mutant alleles were more common in non-responders (28.00%) than in responders (13.33%). Wild-type carriers had 2.59 times higher odds of achieving SVR (OR, 2.59; 95% CI, 1.10–5.83). HFE mutations were significantly associated with elevated serum iron (p = 0.031) and ferritin (p = 0.044) levels, the with C282Y mutation linked to increased iron. However, after multivariate adjustment using principal component analysis, only iron overload remained a significant predictor of non-response (p < 0.001), while the association with HFE mutations was no longer significant (p = 0.647).ConclusionsHFE mutations are associated with lower SVR rates and iron overload, but their impact appears mediated through disrupted iron metabolism. Iron overload emerged as the key independent predictor of treatment failure. These findings underscore the importance of evaluating iron status in conjunction with genetic factors to more accurately predict treatment outcomes in CHC patients receiving direct-acting antivirals.

Hepatic elastography is a reliable, non-invasive imaging technique for assessing liver stiffness, aiding in the diagnosis of liver fibrosis and cirrhosis. Chronic hepatitis B (CHB) and chronic hepatitis C (CHC) contribute significantly to progressive liver disease and hepatocellular carcinoma (HCC) worldwide. Early detection and continuous monitoring of liver stiffness are crucial for effective disease management. However, data on hepatic elastography findings in Rwanda remain limited. This study aimed to describe hepatic elastography findings in patients with CHB and CHC at King Faisal Hospital; describe elastography findings difference in hepatitis B and C and Assess the correlation between demographic and clinical factors and fibrosis severity. A cross-sectional study was conducted among 149 patients with CHB and CHC. Liver stiffness was assessed using point shear wave elastography (pSWE) on the Siemens Acuson Sequoia ultrasound system. Demographic data, liver function tests, viral loads, and fibrosis staging were collected and analyzed using R and R Studio (v.4.3.3). Descriptive statistics were computed, Fisher's exact test was used to assess associations, and multinomial logistic regression was applied to identify key contributors to fibrosis severity. Model accuracy, sensitivity, and specificity were also evaluated. Of the 149 participants, 77 (52%) had CHB and 72 (48%) had CHC. Severe fibrosis (F3-F4) was significantly more prevalent in CHC patients (72%) than in CHB patients (28%) (p = 0.011). Age was a strong predictor of fibrosis severity; patients over 40years were 10.3 times more likely to have advanced fibrosis (p = 0.002). Other significant predictors included patient with longer infection duration (7-12years), hepatic steatosis, abnormal viral load, and without on antiviral therapy (p < 0.001). Elevated AST, ALT, and GGT were strongly associated with advanced fibrosis (p < 0.001). Sex was not significantly associated with fibrosis severity. Elastography findings correlated well with biopsy results, with 84% of patients classified as F3-F4 by elastography confirmed to have advanced fibrosis by biopsy. This study confirms that hepatic elastography is a powerful, non-invasive diagnostic tool for assessing liver fibrosis in patients with chronic hepatitis B and C. Advanced fibrosis and cirrhosis were significantly more prevalent among hepatitis C patients. Several clinical and demographic factors including older age, longer infection duration, hepatic steatosis observed on routine abdominal ultrasound, abnormal viral load, and lack of antiviral therapy were strongly associated with increased liver stiffness. Elevated liver enzymes (AST, ALT, GGT) also showed a significant correlation with fibrosis severity. Sex was not found to be a statistically significant predictor of fibrosis stage. These findings reaffirm the clinical reliability of elastography as a practical alternative to biopsy, particularly in resource-limited settings.

We aimed to evaluate the real-world effectiveness and safety of direct-acting antiviral agents (DAAs) in patients with chronic hepatitis C (CHC) and to describe genotype distribution. Patients diagnosed with CHC and treated with DAAs between June 2016 and January 2023 were included in this single-center, retrospective observational cohort study. Among the 402 patients initially evaluated, 233 patients with available sustained virological response at 12 weeks (SVR12) data were included in the final analysis. The median age was 53 years (range, 18–92), and 50.2% of patients were female; 208 patients (89.3%) were treatment-naïve. Among patients with a single HCV genotype, genotype 1b was the most prevalent. Genotype 3 infection was more frequently observed among individuals with a history of incarceration, alcohol use disorder, and intravenous drug use, whereas genotype 4 was more common among Syrian patients. Overall rates of rapid virological response, end-of-treatment virological response, and SVR12 were 95.6% (n = 195/204), 99.5% (n = 221/222), and 99.6% (n = 232/233), respectively. Compared with baseline, serum albumin concentrations (p = 0.030), WBC counts (p = 0.021), and PLT counts (p < 0.001) increased significantly, while serum AST (p < 0.001), ALT (p < 0.001), ALP (p = 0.011), and GGT (p < 0.001) enzyme activity levels showed significant decreases. Total bilirubin and AFP concentrations also declined significantly (both p < 0.001). Adverse events were infrequent and mild, with fatigue and pruritus (each n = 7, 3.0%) being the most commonly reported. No treatment discontinuation or treatment-related mortality was observed during follow-up. In this real-world cohort, DAA therapy was highly effective and well tolerated, including among vulnerable populations. The observed genotype distribution was consistent with previously reported national data and local population characteristics. These findings likely reflect migration-related epidemiological patterns and changing population dynamics rather than causal relationships. Targeted screening strategies and equitable access to DAAs remain essential for effective HCV control and reduction of its public health burden.

Chronic hepatitis C (CHC) continues to be a significant public health issue in the United States, but comprehensive analysis of its epidemiological characteristics is limited. This analysis used data from the National Notifiable Diseases Surveillance System to examine patterns and changes in newly reported CHC. During 2016-2023, 895,522 CHC cases were newly reported among adults aged ≥ 18 years in the United States. The rate of newly reported cases during 2020-2023 was significantly lower (47.8 cases per 100,000), compared with the rate during 2016-2019 (75.8 cases per 100,000). A distinct bimodal age distribution was observed with age peaks centered at approximately 33.9 and 59.5 years, which corresponds to millennials (born during 1981-1996) and baby boomers (born during 1945-1965), respectively. While the bimodal age distribution persisted, over time, fewer cases contributed to the older peak relative to the younger peak. Males had a significantly higher rate of newly reported CHC than females, as did individuals residing in rural areas compared to urban areas, particularly within the younger peak. Variations in the transition from the older peak to the younger peak were observed across states during 2016-2023. These findings provide valuable insights into the evolving CHC epidemiology and the implications for the efforts to eliminate the disease.

The aim of the study is to assess the features of the epidemic process and clinical and virological characteristics of chronic hepatitis C (CHC) in Saint-Petersburg over a ten-year period (2015–2024). Material and methods . A retrospective epidemiological analysis of the incidence and mortality of CHC in Russia and Saint-Petersburg for 2015– 2024 was carried out based on data from Federal Statistical Surveillance, government reports and reports from medical organizations of various forms of ownership (The Botkin Clinical Infectious Diseases Hospital, Saint-Petersburg, Russia; non-governmental medical clinic EXCLUSIVE, Saint-Petersburg, Russia). The study included 500 outpatient patients with CHC. Results . In the Russian Federation and Saint-Petersburg, in the period from 2014 to 2024, there was a decrease in the incidence of CHC by 1.1 times (p &lt; 0.05), the incidence of CHC in Saint-Petersburg exceeds the national values by 2.4 times. Over the past decade, there has been an increase in cases of hospitalization for both acute and chronic hepatitis C, in 2024 the proportion of patients with CHC was 8.5 %. HCV subtype 1b (53.6 %) and 3а (36.8 %) prevailed. Advanced stages of liver fibrosis (F3 and F4), which determine the need for priority start of antiviral therapy, were noted in 42.1 % of patients, which is almost 2 times more than the national level. Hepatitis C virus monoinfection and hepatitis B and C co-infection were the main causes of liver cirrhosis and hepatocellular carcinoma in hospitalized patients. In the etiological structure of hospital case-fatality, the leading place is occupied by the mixed infection of hepatitis B and C viruses (2024 – 33 %), which is more than 2 times higher than the indicators of the prepandemic period (p &lt; 0.05). Conclusions. The high epidemiological and clinical significance of the CHC burden for Saint-Petersburg in shown, which determines the need to optimize the epidemiological surveillance system, screening programs, as well as access to antiviral therapy.