Hepatitis C

Hepatitis C is a viral infection that causes liver inflammation and can lead to serious liver damage. The virus (HCV) spreads through contaminated blood. Many people with hepatitis C have no symptoms for years or even decades until liver disease is advanced.

Acute infection may clear spontaneously in a minority of people; most develop chronic hepatitis C. Chronic infection can progress to cirrhosis, liver failure, and hepatocellular carcinoma. Direct-acting antiviral (DAA) medicines can cure more than 95% of people with 8–12 weeks of oral treatment and are generally well tolerated. Screening and treatment are the pillars of eliminating hepatitis C as a public-health threat.

Many people have no symptoms until late disease. When symptoms occur, they may include:

• Fatigue
• Fever
• Nausea or poor appetite
• Muscle and joint aches
• Yellowing of the skin or eyes (jaundice)
• Dark urine
• Clay-colored stool
• Abdominal pain (especially right upper quadrant)
• Itching

Advanced chronic disease can present with signs of cirrhosis: fluid in the abdomen (ascites), bleeding varices, confusion (hepatic encephalopathy), easy bruising, and jaundice.

Hepatitis C is caused by infection with the hepatitis C virus. Transmission is primarily blood-borne:

• Sharing needles or other equipment for injecting drugs (most common risk in many countries today)
• Blood transfusion or organ transplant before routine donor screening (early 1990s in many places)
• Needlestick injuries in health-care settings
• Birth to an HCV-infected parent (vertical transmission)
• Less efficient: shared razors or toothbrushes, unregulated tattoos/piercings, sexual transmission (higher with blood exposure or coexistent STI/HIV)

It is not spread by casual contact, breastfeeding (unless nipples are cracked and bleeding), or sharing food and water.

People at higher risk include those who:

• Have ever injected drugs, even once
• Received blood products or transplants before screening was standard
• Have been on long-term hemodialysis
• Have had needlestick injuries
• Were born to an HCV-positive parent
• Have HIV infection
• Were incarcerated
• Have had unregulated tattoos or piercings
• Were born between roughly 1945 and 1965 (birth-cohort screening was historically emphasized in some countries)

Chronic hepatitis C can lead to:

• Cirrhosis
• End-stage liver disease and liver failure
• Hepatocellular carcinoma (liver cancer)
• Portal hypertension and variceal bleeding
• Hepatic encephalopathy
• Extrahepatic manifestations (mixed cryoglobulinemia, kidney disease, lymphoma, skin disorders, diabetes associations)

Cure of HCV with DAAs stops progression of liver disease in most people and reduces, but does not always eliminate, the risk of liver cancer in those who already have advanced fibrosis—ongoing surveillance may still be needed.

There is no vaccine for hepatitis C. Prevention focuses on:

• Not sharing needles or injection equipment; using harm-reduction services
• Standard precautions in health care
• Avoiding unregulated tattoos and piercings
• Not sharing razors or toothbrushes
• Safe sexual practices when blood exposure is possible
• Screening blood and organ donors
• Testing and treating infected people to prevent further transmission

Testing steps:

• HCV antibody test — indicates exposure
• HCV RNA (PCR) — confirms current infection and is used to monitor treatment
• Viral genotype — less often required with pangenotypic DAA regimens but sometimes still used
• Assessment of liver fibrosis — blood-based scores (FIB-4, APRI), elastography (FibroScan), or rarely biopsy
• Screening for hepatitis B and HIV coinfection, and vaccination for hepatitis A and B if not immune

All adults should be offered at least one-time screening in many current guidelines; people with ongoing risk need periodic testing.

See a healthcare professional if you have symptoms of hepatitis or risk factors for HCV (past or current injection drug use, blood transfusion before widespread screening, needlestick injury, birth to an infected parent, or certain other exposures). Universal one-time screening is recommended for all adults in many guidelines, with periodic testing for people with ongoing risk.

Seek care promptly for jaundice, severe abdominal pain, or confusion.

Direct-acting antiviral regimens are the standard of care:

• Oral combinations taken for 8 or 12 weeks in most treatment-naïve patients without cirrhosis
• Pangenotypic options (e.g., sofosbuvir/velpatasvir, glecaprevir/pibrentasvir) simplify treatment
• Cure is defined as sustained virologic response (undetectable HCV RNA) 12 weeks after treatment (SVR12)
• Side effects are usually mild compared with older interferon-based therapy
• Drug-interaction checking is important (especially with acid reducers, anticonvulsants, and some statins and anticoagulants)
• People with decompensated cirrhosis, prior treatment failure, or complex comorbidities benefit from specialist care
• After cure, people with advanced fibrosis still need hepatocellular carcinoma surveillance

Reinfection is possible if risk behaviors continue; harm reduction and repeat testing matter.

During and after treatment:

• Take every dose of antiviral medicine as prescribed
• Avoid alcohol to protect the liver
• Do not share needles or personal items that may have blood
• Get vaccinated against hepatitis A and B if not already immune
• Maintain a healthy weight and manage metabolic conditions
• Attend follow-up to confirm cure and for ongoing liver care if fibrosis is advanced
• Discuss safe timing of pregnancy and breastfeeding with a clinician

Bring:

• Risk-history information (in confidence)
• Previous hepatitis test results
• Complete medication list for interaction checking
• Questions about treatment duration, side effects, cost/access programs, and follow-up after cure
• Alcohol and substance-use history so support can be offered