Hepatitis C

Hepatitis C is an infection of the liver caused by a virus that spreads through infected blood. It can be short-term (acute) or long-term (chronic).

A minority of people clear the virus within about six months. For most it becomes chronic and, untreated, can over many years scar the liver (cirrhosis) and lead to liver cancer. Modern tablets cure the great majority of people.

Most people have no symptoms, at first or for years. A new infection can cause, a few weeks to months after exposure:

• Tiredness and fever
• Loss of appetite, nausea and vomiting
• Pain in the upper tummy and joint pain
• Dark urine and pale stools
• Yellow skin and eyes (jaundice)

Long-standing infection may cause ongoing tiredness and itchy skin. Swelling, confusion and weight loss suggest a badly scarred liver.

See a doctor if you have yellow eyes or skin, dark urine, pale stools or unexplained tiredness. See one soon, even if you feel well, if you may have been exposed, for example by a needle-stick injury, shared needles or razors, unscreened blood or unsterile procedures.

The virus passes on when infected blood enters another person's body. Common routes are:

• Reused or unsterile needles, syringes and instruments in health care
• Unscreened blood or blood products
• Shared needles and drug-injecting equipment
• Unsterile tattoo or piercing tools
• Shared razors, toothbrushes or nail cutters
• Mother to baby during pregnancy or birth, and rarely sex involving blood

It does not spread through coughing, hugging, kissing, food, water or shared plates.

• Injecting drugs
• Past injections or procedures with unsterile equipment, or a transfusion of unscreened blood
• Kidney dialysis
• Health-care work with exposure to blood or needles
• HIV infection
• Being born to a mother with hepatitis C

Left untreated, chronic hepatitis C can cause scarring of the liver (fibrosis and cirrhosis), liver failure and liver cancer. These take many years, and heavy alcohol use, hepatitis B or HIV can speed them up. People with cirrhosis need regular scans to look for liver cancer.

There is no vaccine, so prevention means avoiding contact with infected blood:

• Insist on a new, sterile needle and syringe for every injection, and sterile instruments for dental and other procedures
• Do not share needles, razors, toothbrushes or nail cutters
• Choose tattoo and piercing studios that use sterile tools
• Use condoms, which lowers the small risk of spread through sex
• You can catch hepatitis C again after having it or being cured

If you have hepatitis C, tell your doctor and dentist, and do not donate blood.

Only a blood test can show hepatitis C. Testing has two steps:

• An antibody test shows whether you have ever been in contact with the virus
• If positive, an HCV RNA test checks whether the virus is still active, because some people clear it on their own

A test soon after exposure can miss a new infection and may be repeated. If the infection is active, blood tests, an ultrasound, elastography (a scan of liver stiffness) and sometimes a biopsy show how much the liver is affected.

Hepatitis C is treated with direct-acting antiviral tablets. A course usually lasts about two to six months, depending on the medicine and on whether the liver is scarred, and has few side effects. They cure the great majority of people, if the full course is finished.

Blood tests during and after treatment confirm the virus has gone. Treatment is advised for nearly everyone with chronic infection, with exceptions the doctor will explain, such as pregnancy.

Do not take any herbal product, supplement or other medicine without asking the doctor, as some can harm the liver or interfere with treatment. Avoiding alcohol protects the liver.