Hepatitis C

Hepatitis C is an infection of the liver caused by the hepatitis C virus. The liver is a vital organ that filters the blood and helps with digestion, so a long-running infection can gradually damage it.

In some people the body clears the virus on its own within the first few months. In most, however, it becomes a long-term, or chronic, infection that can quietly damage the liver over many years if it is not treated.

The most important change in recent years is that hepatitis C is now considered curable in the large majority of people. Modern tablet treatments are short, well tolerated, and highly effective, which is why finding the infection through testing matters so much.

Hepatitis C often causes no symptoms at all, especially in the early years, which is why many people do not know they have it. When symptoms do occur they can be vague, such as tiredness, aching muscles and joints, poor appetite, feeling sick, and tummy discomfort.

As liver damage advances after many years, signs such as yellowing of the skin and eyes (jaundice), itchy skin, swelling of the abdomen, and easy bruising can appear. Because early infection is usually silent, testing is the only dependable way to detect it.

The virus is carried in blood and spreads when blood from an infected person enters another person's bloodstream. The most common route worldwide is sharing needles or other equipment to inject drugs.

It can also be passed through unsterile medical, dental or tattooing equipment, through blood products in places without reliable screening, by sharing razors or toothbrushes that carry traces of blood, and from a mother to her baby during birth. It is not spread by hugging, sharing food, coughing or other everyday contact.

Diagnosis begins with a blood test that checks for antibodies to the virus, which show whether you have ever been exposed. If this is positive, a second blood test looks for the virus itself to confirm whether you currently have an active infection.

If infection is confirmed, further tests assess how much the virus is present and check the condition of the liver. The amount of any liver scarring is often measured using blood tests and a painless scan, which helps guide treatment and follow-up.

Hepatitis C is treated with direct-acting antiviral medicines, taken as tablets. These have transformed care: they cure the great majority of people who take them, usually within a course of around two to three months, and most people have few or no side effects.

After treatment, a blood test is done some weeks later to confirm the virus has been cleared. Being cured greatly reduces the risk of future liver damage. It is still possible to catch the virus again, so avoiding further exposure remains important.

Where the liver has already been significantly scarred, ongoing monitoring is recommended even after the virus is cleared, because some risks to the liver can persist.

If a chronic infection is left untreated for many years, continuing inflammation can lead to extensive scarring of the liver, known as cirrhosis. Cirrhosis can stop the liver working properly and cause serious problems.

People with long-standing infection and cirrhosis also have an increased risk of liver cancer. These serious outcomes are an important reason to test for hepatitis C and to treat it, since cure prevents most of this future harm.

There is no vaccine against hepatitis C, so prevention focuses on avoiding contact with infected blood. This includes never sharing needles or injecting equipment, ensuring tattoos and piercings use sterile equipment, and not sharing personal items such as razors or toothbrushes.

The outlook today is very positive. With modern tablet treatment, most people are cured, and curing the infection before serious liver damage develops allows many to expect a normal, healthy life.