All you need to know about: Hepatitis C

Hepatitis C is one of the few chronic viral infections that can now be cured. Yet it continues to cause hundreds of thousands of deaths each year because many people are diagnosed only after serious liver damage has occurred. According to the World Health Organization (WHO), an estimated 47 million people were living with chronic Hepatitis C infection globally, with around 0.9 million new infections and 239,000 deaths in 2024, mostly due to cirrhosis and liver cancer. In India, the National Viral Hepatitis Control Programme aims to improve diagnosis and provide free treatment through public health facilities.

What is Hepatitis C?

Hepatitis C is a liver disease caused by the Hepatitis C virus (HCV). Unlike Hepatitis A, which spreads mainly through contaminated food and water, Hepatitis C spreads through contact with infected blood. Around three in ten people clear the virus naturally within six months without treatment. However, most develop a chronic infection that can slowly damage the liver over many years. This may lead to fibrosis (scarring of the liver), cirrhosis, liver failure and hepatocellular carcinoma, the most common type of primary liver cancer.

Hepatitis C is often called a “silent” infection because many people have no symptoms until significant liver damage has already developed. Although there is no vaccine to prevent Hepatitis C, modern direct-acting antiviral medicines can cure more than 95% of infections.

How does Hepatitis C spread?

Hepatitis C spreads when blood from an infected person enters the bloodstream of someone who is not infected. The most common route of transmission globally is the sharing of needles and syringes among people who inject drugs. The virus can also spread through unsafe medical injections, poorly sterilised medical or dental equipment, transfusion of unscreened blood or blood products, and accidental needle-stick injuries among healthcare workers.

Transmission from an infected mother to her baby during childbirth can occur but is uncommon. Sexual transmission is possible, although it is much less common than blood-borne transmission and is seen more often among people living with HIV or those with multiple sexual partners.

The virus does not spread through hugging, kissing, sharing food or drinking water, coughing, sneezing or breastfeeding.

What are the signs and symptoms?

Many people with acute Hepatitis C do not develop symptoms. When they do occur, symptoms usually appear between two weeks and six months after infection and may include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, joint pain, dark urine, pale stools and jaundice, or yellowing of the eyes and skin.

Because the infection often causes no symptoms, many people remain undiagnosed for years.

How is it diagnosed?

Diagnosis usually begins with a blood test that looks for antibodies against the Hepatitis C virus. A positive result shows that a person has been infected at some point, but it does not confirm whether the infection is still active. A second test that detects HCV RNA is therefore needed to confirm the presence of the virus.

Once an active infection is confirmed, doctors may use blood tests and scans to assess the extent of liver damage and determine the most appropriate treatment. WHO also recommends testing people at higher risk of infection, including people who inject drugs, recipients of unscreened blood transfusions, healthcare workers with occupational exposure, and people living with HIV.

What are the treatment options?

Treatment for Hepatitis C has changed dramatically over the past decade. Direct-acting antiviral medicines can cure more than 95% of infections. Treatment usually lasts 12 to 24 weeks, depending on the presence of cirrhosis and the treatment regimen. Early diagnosis and treatment greatly reduce the risk of cirrhosis, liver failure and liver cancer.

Expanding testing, diagnosis and access to treatment could prevent millions of new infections and significantly reduce deaths from liver disease. Experts now consider eliminating Hepatitis C a realistic public health goal, provided countries continue to improve access to screening and treatment.

Can Hepatitis C be prevented?

Unlike Hepatitis A and Hepatitis B, there is currently no vaccine against Hepatitis C. Researchers are working on vaccine candidates, but none has been approved yet.

Prevention depends on avoiding exposure to infected blood. The WHO recommends safe injection practices, screening all donated blood and blood products, proper sterilisation of medical and dental equipment, safe handling and disposal of needles and medical waste, strict infection-control measures in healthcare settings, and access to sterile needles and syringes and other harm-reduction services for people who inject drugs. Practising safer sex using barrier methods such as condoms can also reduce the risk in situations where there may be exposure to blood.