Hepatitis C
Hepatitis C is a liver infection caused by the hepatitis C virus (HCV). Unlike hep A and B, which have vaccines, there is no vaccine for hepatitis C. The infection is usually acquired through blood-to-blood contact. Hepatitis C is often called a “silent” disease because it typically causes no symptoms until significant liver damage has occurred. A crucial fact about HCV is that it can be cured in the vast majority of cases with modern treatments. Chronic hepatitis C is a leading cause of cirrhosis and liver cancer worldwide, but recent advances in therapy have made it possible to eliminate the virus in infected individuals.
Symptoms
Most people with newly acquired hepatitis C have no symptoms or only very mild, flu-like symptoms, so the acute phase often goes unnoticed. If symptoms of acute HCV occur (in the minority of patients), they can include:
- Fatigue and malaise (feeling “run down”).
- Fever and body aches.
- Poor appetite, nausea, vomiting, and abdominal pain.
- Dark urine and pale stools.
- Jaundice (yellowing of skin or eyes) – this occurs in some cases of acute hepatitis C, but not all.
These symptoms, if they occur, usually present 2 to 12 weeks after exposure (but can take as long as 6 months to appear). They often last several weeks.
After the acute phase, if the virus isn’t cleared, hepatitis C usually becomes chronic. Chronic HCV infection typically produces no symptoms for years. The person may feel well while the virus slowly damages the liver. Some people with chronic hepatitis C experience general fatigue or subtle symptoms, but many have none. When liver damage becomes advanced (cirrhosis), symptoms like fatigue, abdominal swelling, easy bruising, or jaundice can develop. Often, people first discover HCV when they have abnormal liver blood tests or if they belong to a high-risk group and get tested.
Causes
Hepatitis C is caused by the hepatitis C virus, which is a blood-borne virus. Major routes of HCV transmission include:
- Injecting drug use: The most common mode in many countries today. Sharing needles, syringes, or other injection equipment can easily transmit HCV. Even tiny, invisible amounts of blood can carry the virus.
- Unsafe medical practices or needle-stick injuries: In healthcare settings with inadequate sterilization, reuse of needles or medical equipment can spread HCV. Accidental needle-sticks in healthcare workers can also transmit it.
- Blood transfusions and organ transplants (prior to screening): Before 1990, HCV was often spread through transfused blood or transplanted organs. Now, in most countries, the blood supply is screened for HCV, and this risk is extremely low.
- Tattooing or body piercing with unsterile equipment: Needles or ink contaminated with infected blood can spread HCV if proper sterilization isn’t followed.
- Mother-to-child transmission: An HCV-positive mother can pass the virus to her baby during childbirth, though this is less common (about 5% of births). The risk is higher if the mother has a high viral load or is HIV-positive.
- Sexual transmission: Less common than with HBV. Can occur when blood is present (e.g., rough sex, menstrual blood) or among people with multiple partners or co-existing STIs. Higher risk has been reported among men who have sex with men, especially those who are HIV-positive.
- Household contact (rare): Sharing personal items that might have blood (razors, toothbrushes) could possibly transmit HCV, though this is considered uncommon.
Hepatitis C is not spread by casual contact, kissing, hugging, coughing, or sharing eating utensils or food. It requires blood (or sometimes bodily fluids containing blood) to enter the bloodstream of an uninfected person.
About 15–45% of people who get HCV are able to clear the virus spontaneously (usually within 6 months) without treatment, especially if they have strong immune responses. However, the majority (~55–85%) cannot clear it and develop chronic infection. Risk factors for acquiring hepatitis C include a history of injection drug use, receiving blood products before screening was in place, birth in certain regions (HCV is more common in some countries), and others.
Diagnosis
Hepatitis C is typically diagnosed through blood tests:
- HCV Antibody Test: A screening test that checks if you have ever been exposed to hepatitis C by detecting antibodies. A positive result means you have been infected at some point (past or present).
- HCV RNA Test (PCR test): If the antibody test is positive, a follow-up PCR test detects the presence of HCV genetic material (RNA) in the blood. This confirms an active infection and measures the viral load. If RNA is detected → current infection. If not detected (but antibody is positive) → past infection that has cleared.
- Genotype Test: Determines which strain (genotypes 1–6) of HCV you have, since treatment can vary slightly by genotype.
- Liver function tests: Measures ALT, AST, bilirubin, etc. Many people with chronic HCV show fluctuating or mildly elevated liver enzymes, indicating liver inflammation.
- Liver fibrosis assessment: For chronic hepatitis C, doctors assess liver health using FibroScan (specialized ultrasound) or sometimes a biopsy. This checks for fibrosis or cirrhosis, helping guide treatment urgency.
It’s recommended that certain populations get tested for HCV even without symptoms – for example, anyone with risk factors or all adults in certain age groups (many countries advise a one-time test for all adults born between 1945–1965, as that cohort has higher prevalence).
Treatment
Treatment for hepatitis C has been revolutionized in recent years. Direct-acting antiviral (DAA) medications can cure >95% of chronic HCV infections with a short course of pills. Key points of treatment:
- DAA Regimens: Modern therapy involves 8–12 weeks of oral antivirals that block the virus from replicating. Examples include sofosbuvir, ledipasvir, velpatasvir, glecaprevir, pibrentasvir, and others. These medicines are highly effective, well-tolerated, and achieve cure rates above 95% in most patients.
- Cure = SVR: A patient is considered cured when they achieve a sustained virologic response (SVR), meaning no HCV detected in the blood 12 weeks after completing treatment. Once cured, liver damage progression stops. ⚠️ Cure does not protect against reinfection.
- Who gets treated: Almost everyone with chronic hepatitis C is now eligible for treatment, even with early disease, since cure improves long-term health and prevents spread. Exceptions may include patients with very short life expectancy from other conditions.
- Monitoring and follow-up: During treatment, blood tests track viral load reduction. After therapy, a test at 12 weeks confirms cure. Patients with advanced fibrosis or cirrhosis still need ongoing monitoring (e.g., ultrasounds for liver cancer screening).
Earlier treatments (interferon injections with ribavirin) were difficult to tolerate and less effective. But now with DAAs, treating hepatitis C has become much easier and safer.
Additionally, patients should avoid alcohol and liver-toxic substances during treatment and beyond, to help the liver heal. There is no vaccine, so preventing reinfection through harm reduction (like not sharing needles) is important even after cure.
FAQs
Yes. The word “cure” is now applicable to hepatitis C. With modern direct-acting antivirals, over 95% of people are cured of HCV infection after a course of treatment. Cure means the virus is completely eliminated – it will no longer be in your blood or attacking your liver. Even people who have had HCV for decades can usually be cured. It’s one of the great successes in medicine recently. However, after being cured, one can be re-infected if exposed again, since having had HCV does not make you immune. So it’s important to take precautions (avoid sharing needles, etc.) even after successful treatment.
Correct, there is currently no vaccine to prevent hepatitis C. To protect yourself, you need to avoid exposure to the virus. Major precautions include: never share needles or any injection equipment; ensure any tattoos or piercings are done with new, sterile needles; use condoms to reduce risk (especially if you have multiple partners, though sexual transmission risk is lower than for hep B); and be cautious about personal items that might have blood (razors, toothbrushes). Healthcare settings in developed countries follow strict infection control, so medical-related transmission is rare now – but in places with less oversight, ensure needles or medical tools are sterile. If you use IV drugs, consider using needle exchange programs for clean syringes. Being informed and cautious about blood exposure is the best prevention since we don’t have a vaccine yet.
If you have any risk factors (past or present injection drug use, blood transfusion before early 1990s, long-term hemodialysis, HIV-positive status, etc.) or if you were born in an age group with higher HCV prevalence, it’s worth getting tested. Hepatitis C often causes no symptoms until the liver is significantly damaged. You can be infected for 10–20 years silently. A simple blood test can tell if you have it. Early diagnosis is important because now that we have curative treatment, we can prevent liver damage by treating you sooner rather than later. Many health authorities actually recommend a one-time test for all adults of a certain age range (for example, those born 1945–1965 in the US) regardless of risk, because so many people in that cohort had unrecognized HCV. So yes – feeling fine doesn’t rule out HCV. Testing is the only way to know.
Yes. Unlike some infections, having hepatitis C once does not make you immune. People can be reinfected with HCV after clearing it, whether clearance happened spontaneously or via treatment. There are multiple strains of HCV, and prior infection doesn’t protect you from a new one. This is why even patients who are cured with medication must continue to practice prevention (for instance, if a person with a history of injection drug use is cured, they can get a new HCV infection if they resume unsafe injection practices). Reinfection is absolutely possible, so ongoing risk reduction is key.
Chronic hepatitis C can progressively damage the liver. Over years or decades, ongoing inflammation may lead to fibrosis (scar tissue formation). In about 15–30% of chronic HCV patients, this can progress to cirrhosis over 20 years or so. Cirrhosis is serious – it can result in liver failure and its complications (ascites, variceal bleeding, encephalopathy). Moreover, chronic HCV (especially in the setting of cirrhosis) greatly increases the risk of liver cancer (hepatocellular carcinoma). Hepatitis C is a top cause of liver transplants due to liver failure or liver cancer. The good news is that curing HCV greatly reduces these risks. If caught before advanced cirrhosis, a cure allows the liver to heal and the risk of cirrhosis or cancer drops dramatically in the future.