Hepatitis C
A blood-borne viral liver infection now curable with short oral antiviral courses.
Overview
Hepatitis C virus (HCV) is a blood-borne RNA virus. Most acute infections are silent; chronic infection causes progressive fibrosis, cirrhosis and liver cancer. Modern direct-acting antivirals cure >95% of infections in 8–12 weeks.
Symptoms
- • Often asymptomatic for years
- • Fatigue, low mood, joint aches
- • Right-upper-quadrant discomfort
- • Jaundice in acute infection or decompensated cirrhosis
Risk factors
- • Injection drug use (current or past)
- • Receipt of blood products before screening era
- • Healthcare exposure, needlestick
- • HIV co-infection
- • Country of origin with high prevalence
Causes
- • HCV transmission via blood: injection drug use, unsterile medical/tattooing equipment, pre-1992 blood transfusion in many countries
- • Less commonly sexual (highest risk in HIV-positive MSM) and vertical transmission
🚨 Red flags — seek urgent care
- • Severe jaundice with confusion or bleeding — emergency
- • Vomiting blood or melaena
- • Worsening ascites with fever
When to seek care
- • Risk factors — request testing
- • Persistent fatigue, abnormal liver tests
- • Pregnancy with risk factors
Diagnosis
- • Anti-HCV antibody screen; confirm with HCV RNA
- • Genotype is no longer required for most modern pangenotypic regimens
- • Fibrosis staging with FibroScan
- • Screen for HBV and HIV co-infection
Treatment
- • Direct-acting antivirals (sofosbuvir/velpatasvir, glecaprevir/pibrentasvir) — 8–12 weeks, >95% cure
- • Treat regardless of fibrosis stage
- • Manage cirrhosis complications and continue HCC surveillance after cure if cirrhosis present
- • Harm-reduction and addiction support if active injection use
Prevention
- • Needle and syringe exchange, opioid substitution therapy
- • Universal precautions in healthcare
- • Avoid sharing razors, toothbrushes
- • Screening of blood products and donors
- • No effective vaccine currently exists
Complications
- • Cirrhosis and hepatocellular carcinoma
- • Cryoglobulinaemia, glomerulonephritis
- • Lymphoma (rare)
- • Extrahepatic: fatigue, cognitive impairment
Prognosis
With DAAs, cure (sustained virological response) is achieved in >95%. Risk of cirrhosis and HCC falls sharply after cure but remains elevated in those with established cirrhosis.
Education & self-care
Hepatitis C is curable. Anyone with risk factors should be tested; treatment is short, well tolerated and highly effective.
Frequently asked questions
Is hepatitis C really curable?
Yes — modern direct-acting antivirals cure more than 95% of people in 8–12 weeks with minimal side effects.
Can I get reinfected after cure?
Cure does not prevent reinfection. Ongoing risk reduction is important if injection or sexual risk continues.
Is hepatitis C still incurable?
No. Direct-acting antivirals (8–12 weeks of tablets) cure over 95% of people across all genotypes, including those with cirrhosis.
How is it caught?
Mainly through blood-to-blood contact — sharing injecting equipment, unsterile tattoos or medical procedures, and (less often) sexual transmission. Pre-1991 blood transfusion is also a historical risk.
Will treatment reverse liver damage?
Inflammation falls quickly after cure, and early fibrosis can regress. Established cirrhosis remains, but the long-term risk of liver cancer and decompensation is substantially reduced.