Hepatitis C

Overview

Hepatitis C is a liver infection caused by the hepatitis C virus (HCV). It can be a short-term illness, but for many people it becomes a long-term, chronic infection that can damage the liver over time.

Hepatitis C is common around the world, affecting about 58 million people. It is most common in certain regions, including parts of Africa, Central and East Asia, and the Middle East.

Anyone can get hepatitis C, but it is more common in people who have received a blood transfusion before 1992, people who inject drugs, and people who have had unprotected sex with an infected person. Healthcare workers who are exposed to infected blood are also at risk.

Symptoms

Common symptoms

• Fatigue (feeling very tired)
• Nausea and loss of appetite
• Jaundice – yellowing of the skin and whites of the eyes
• Dark urine and pale stool
• Pain in the upper right side of the belly (where the liver is)
• Fever

Symptoms in children

• Children may have no symptoms at all, or they may have mild fatigue or jaundice.

Symptoms in older adults

• Older adults may have more severe fatigue, confusion or memory problems, and swelling in the legs or belly due to liver damage.

Causes

Main causes

• Hepatitis C is caused by the hepatitis C virus. It is spread when blood from an infected person enters the body of someone who is not infected.

Risk factors

• Injecting drugs with shared needles or equipment
• Receiving a blood transfusion, organ transplant, or blood products before 1992 (when blood screening began)
• Being born to a mother with hepatitis C
• Having unprotected sex with multiple partners or with someone who has hepatitis C
• Sharing personal items like razors or toothbrushes that might have blood on them
• Working in healthcare and being accidentally stuck with a needle

When to see a doctor

See a doctor urgently if:

• If you have symptoms of jaundice (yellow skin or eyes)
• If you have severe belly pain or vomiting
• If you have been exposed to blood from someone who has hepatitis C (for example, a needlestick injury)

Book a routine appointment if:

• If you think you may have been at risk for hepatitis C – even if you have no symptoms – talk to your doctor about getting tested.
• If you have a chronic condition like HIV or hepatitis B, or have tested positive for hepatitis C before, talk to your doctor about ongoing care.

Diagnosis

Hepatitis C is diagnosed with a blood test. First, a screening test checks for antibodies to the virus. If that test is positive, a follow-up test checks for the virus itself to confirm an active infection.

Tests that may be done

• Antibody test – a blood test that shows if you have ever been infected with hepatitis C
• RNA test – a blood test that shows if you currently have the virus in your body
• Liver function tests – blood tests that check how well your liver is working
• Liver scarring check – sometimes an ultrasound or a special scan (FibroScan) to see if the liver is damaged

What to expect at your appointment

If you are diagnosed with hepatitis C, your doctor will talk with you about the type and stage of infection. You may be referred to a specialist in liver diseases (hepatologist) or infectious diseases. The doctor will also check for other conditions like HIV or hepatitis B. Most people will need a few blood tests and possibly a liver scan to plan treatment.

Treatment

Hepatitis C can be cured with modern treatment. The goal is to clear the virus from your body and prevent liver damage. Treatment is usually a course of oral medications that you take every day for 8 to 12 weeks. Most people have no serious side effects and are cured.

Self-care at home

• Get plenty of rest if you feel tired.
• Eat a healthy, balanced diet – but avoid raw shellfish and undercooked meat if your liver is damaged.
• Do not drink alcohol – alcohol can speed up liver damage.
• Talk to your doctor before taking any over-the-counter medicines or supplements, as some can harm the liver.
• If you inject drugs, use clean needles and syringes every time.

Medical treatments

Treatment for hepatitis C usually involves a combination of medications that directly target the virus (direct-acting antivirals). These are pills taken by mouth for a set number of weeks. The specific medication your doctor prescribes will depend on the type of hepatitis C you have, your liver health, and any other medical conditions. Treatment is highly effective, with cure rates over 95%.

When is surgery considered?

Surgery is not a treatment for hepatitis C. In rare cases of advanced liver damage (cirrhosis) or liver cancer, a liver transplant may be considered. This is major surgery, and you would need a full evaluation by a transplant team.

Living with this condition

Most people with hepatitis C can live a normal life during and after treatment. You may need to adjust your daily routine if you feel tired, but many people have no symptoms. It is important to avoid spreading the virus to others. Do not share razors, toothbrushes, or nail clippers. Cover any cuts or wounds. If you have sex, using condoms reduces the risk of passing the virus to a partner.

Lifestyle tips

• Eat a healthy diet with plenty of fruits, vegetables, and whole grains.
• Stay active – gentle exercise like walking can help with fatigue.
• Limit or avoid alcohol completely.
• Get vaccinated against hepatitis A and hepatitis B – these viruses can cause further liver damage.
• If you take any medicines or herbal remedies, check with your doctor that they are safe for your liver.

Diet and exercise

A balanced diet helps your liver stay healthy. Eat plenty of fruits, vegetables, lean proteins, and whole grains. Limit salty, fatty, and processed foods. Try to stay at a healthy weight – excess weight can worsen liver damage. Regular moderate exercise, like brisk walking for 30 minutes most days, can improve energy and overall health.

Mental health and emotional wellbeing

A diagnosis of hepatitis C can cause anxiety, depression, or fear about the future. It can also be stressful to take medication and attend appointments. If you feel overwhelmed, talk to your doctor or a mental health professional. Many people find support groups helpful – hearing from others who have been through treatment can be encouraging.

Prevention

Yes, you can reduce your risk of getting hepatitis C. Avoid sharing needles, syringes, or other equipment used to inject drugs. Do not share personal items like razors or toothbrushes. If you have sex, using condoms can reduce risk, especially if you have multiple partners. Healthcare workers should follow safety procedures to avoid needlestick injuries.

Vaccines

There is no vaccine for hepatitis C. However, you should be vaccinated against hepatitis A and hepatitis B if you have hepatitis C, as these viruses can cause more liver damage.

Screening programmes

Screening is recommended for people at higher risk, such as those who have ever injected drugs, people who received blood products before 1992, people with HIV, and people born in countries where hepatitis C is common. Talk to your doctor about whether you should be tested.

Complications

If left untreated

• Chronic hepatitis C can lead to scarring of the liver (cirrhosis), which can cause the liver to stop working properly.
• Liver cancer – people with cirrhosis from hepatitis C are at higher risk for liver cancer.
• Liver failure – when the liver can no longer do its job, which can be life-threatening.

Long-term outlook

The outlook for hepatitis C is very good. Most people can be cured with a short course of oral medication. Treatment can stop further liver damage and greatly reduce the risk of liver cancer and cirrhosis. Even if you have had the virus for many years, modern treatment can clear it. With early treatment, people can live long, healthy lives.

Find support

International organisations

• World Health Organization (WHO) ↗

Local organisations

• NHS – Hepatitis C information ↗ · UK

Helplines

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