Medicines for Hepatitis C

What it is

Hepatitis C is an infection of the liver caused by the hepatitis C virus (HCV). It is spread mainly through blood-to-blood contact — most commonly through sharing needles or other equipment for injecting drugs, but also through contaminated blood (for example unsafe medical, dental, or tattooing procedures in some settings, or blood transfusions before screening was introduced), from mother to baby in some cases, and, less commonly, through certain sexual practices. It is not spread through casual contact such as hugging or sharing food. A key feature of hepatitis C is that it often causes no symptoms for many years, so many people are unaware they are infected; when symptoms do occur, they can be vague, such as tiredness, flu-like symptoms, tummy problems, and, in some cases, jaundice. In some people, a new infection clears on its own, but in many it becomes a long-term (chronic) infection, which, over many years, can lead to liver damage (including cirrhosis) and an increased risk of liver cancer — though this often develops silently, which is why testing is so important. The extremely important and hopeful development in hepatitis C is that it is now curable in the great majority of people with modern antiviral medicines: short courses of well-tolerated tablets (direct-acting antivirals), usually taken for a number of weeks, cure most people of the infection. This has transformed hepatitis C from a long-term condition into a curable one for most people. Because hepatitis C often has no symptoms but is now curable, testing people who may be at risk is crucial — it allows the infection to be found and cured, preventing liver damage and onward spread. The key messages are that hepatitis C often has no symptoms, that it is now curable in most people with short antiviral tablet courses, and that testing those at risk is very important.

How it is treated

The management of hepatitis C has been transformed by modern antiviral treatments, and the priorities are testing people at risk (as it often has no symptoms), curing the infection with these treatments, and preventing spread and liver damage. Testing is a crucial first step: because hepatitis C frequently causes no symptoms for years, many people do not know they have it, so testing is recommended for anyone who may be at risk — for example people who have ever injected drugs (even once, long ago), people who received blood or blood products before screening was in place or in settings where blood may not have been screened, and others with risk factors; testing is straightforward and allows infection to be found and treated. Treatment is now highly effective: direct-acting antiviral (DAA) medicines, taken as tablets usually over a number of weeks, cure the great majority of people of hepatitis C, and are generally well tolerated; treatment is guided by specialists, and cure is confirmed with a blood test after treatment. Curing the infection prevents ongoing liver damage and removes the risk of passing it on. Alongside treatment, looking after the liver (for example avoiding or limiting alcohol), being vaccinated against hepatitis A and B, and assessing the liver for any damage are part of care; where significant liver damage (such as cirrhosis) has already developed, ongoing monitoring is needed even after cure. Preventing spread — for example not sharing needles or injecting equipment, and care with procedures involving blood — is important, and people can be re-infected after cure if exposed again, so avoiding risk continues to matter. The reassuring and important messages are that hepatitis C often has no symptoms, that it is now curable in most people with short, well-tolerated courses of antiviral tablets, and that testing those at risk is crucial — because finding and curing the infection prevents liver damage and onward spread. Anyone who may be at risk is encouraged to get tested.