Hepatitis C
Hepatitis C is a viral infection that settles in the liver and can go years without announcing itself.
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Medicines commonly prescribed for Hepatitis C
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 100/40 mgActive substance: glecaprevir and pibrentasvirManufacturer: Abbvie Deutschland Gmbh & Co. KgPrescription requiredDosage form: TABLET, 400/100/100 mgActive substance: sofosbuvir, velpatasvir and voxilaprevirManufacturer: Gilead Sciences Ireland Unlimited CompanyPrescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 50 mg/20 mgActive substance: glecaprevir and pibrentasvirManufacturer: Abbvie Deutschland Gmbh & Co. KgPrescription required
Hepatitis C is a viral infection that settles in the liver and can go years without announcing itself. That is exactly what makes it awkward: a person feels perfectly ordinary while working liver tissue is quietly replaced by scar tissue. The good news outweighs the bad, though. Over the past decade hepatitis C has stopped being a life sentence and become an illness cured by a course of tablets in two or three months in almost everyone who gets as far as treatment. The difficulty is no longer the medicines — it is getting tested in time.
Why the infection goes unnoticed for years
The first six months after infection are called the acute stage. Only about one person in three or four notices anything at all during that time, usually a few weeks in: weakness, fever, appetite gone, queasiness, a dragging feeling under the right ribs. In some the urine darkens, the stools turn pale and the whites of the eyes go yellow. All of it is easily mistaken for food poisoning or a cold that has dragged on.
In roughly one person in four the immune system clears the virus on its own within a few months. In everyone else the infection stays: this is chronic hepatitis C, and its complaints are unspecific.
- Tiredness that rest does not fix.
- Aching joints and muscles.
- Nausea, heaviness or bloating after meals.
- Trouble concentrating and holding on to recent things — many people call it brain fog.
- Irritability, low mood, anxiety.
- Itchy skin with no rash.
All of this dies down for months and comes back, and is usually put down to age and poor sleep. No single sign points to hepatitis C on its own, and plenty of people have none of them. Only a blood test gives the answer.
How the virus gets into the blood
Hepatitis C is passed on through blood. There is so much virus in it that an invisible trace is enough, and in a dried spot on a surface the virus stays alive for up to several weeks. That accounts for the whole list of routes:
- shared needles and syringes when injecting drugs, along with the spoons, filters and tubes used for snorting powders — once is enough;
- medical and dental procedures where instruments are poorly sterilised;
- transfusions and transplants from before donated blood began to be screened for this virus, which in most countries started in the early nineties;
- tattoos, piercings, permanent make-up and manicures done with unsterile equipment, and at home a shared razor, toothbrush or nail scissors;
- an accidental needlestick at work: for healthcare staff the risk after such an injury is put at roughly one case in fifty;
- from mother to baby during birth, in about one case in twenty. Breast milk does not carry the virus and breastfeeding is fine; the exception is cracked, bleeding nipples;
- through sex the risk is low, but it rises wherever blood is involved: anal sex, sex during a period, sores from other infections, or HIV in one partner.
What there is no need to worry about is kissing, hugging, shared crockery, toilet seats, swimming pools, coughing or insect bites — the virus does not travel that way. In everyday life someone with hepatitis C is no danger to anyone and needs no separate plates.
Who should be tested even while feeling well
The point of testing is to find the infection before it spoils the liver. Anyone touched by even one item on the list above should be tested, and all the more so if it happened long ago and only once: those are precisely the cases that get missed. A few more reasons belong alongside them:
- being from a region where the infection is common, or having lived there for a long time;
- hepatitis C in your mother, your regular partner or someone you live with;
- unexplained raised liver enzymes on a blood test, or living with HIV or hepatitis B;
- planning a pregnancy when any of the above applies to you.
Testing once is worth doing even with no particular reason, simply to close the question. Anyone whose risk continues should ask their doctor how often to repeat it.
The two tests that settle it
The diagnosis rests on two investigations, and it pays not to confuse them: that confusion is a common source of unnecessary panic.
The antibody test shows whether the body has ever met hepatitis C. Antibodies do not appear straight away — it takes anywhere from several weeks to several months — so after a recent risk the test is repeated. A positive result does not yet mean illness, because antibodies stay for life in people who cleared the virus themselves or were treated years ago.
The PCR test for viral RNA answers the question that matters: whether the virus is in the blood now. That is the test that confirms or rules out the diagnosis.
Home finger-prick tests detect antibodies and are a reasonable first step, but any positive result is checked again in a laboratory.
If the virus is found, the liver is assessed with blood chemistry, an ultrasound scan and elastography, which measures how stiff the liver is without any needle. Hepatitis B and HIV are checked at the same time, since both change the treatment plan.
Treatment: tablets instead of injections
Hepatitis C is treated with direct-acting antiviral tablets, which block the virus from copying itself at several stages at once. A course usually runs from eight to twelve weeks and cures more than nine people in ten. The old regimen of weekly interferon injections, gruelling and often unsuccessful, belongs to the past. A few things are worth knowing before starting.
- The course is easy to tolerate. Headache, nausea or poor sleep may show up in the first days, after which things settle.
- Doses must not be skipped and the course must not be stopped early: the virus can become resistant, and a second attempt is then harder to plan.
- List for your doctor everything you take, over-the-counter products and herbs included. These tablets sit badly with certain heart medicines, statins, anti-epileptic drugs, indigestion remedies and St John's wort.
- If you have ever had hepatitis B, treatment can wake it up again, and that is watched separately.
- In pregnancy treatment is postponed, as these medicines have not been studied in pregnant women.
Twelve weeks after the last tablet a check-up PCR is done: a negative result means the virus has gone for good. But no immunity is left behind and there is no vaccine against hepatitis C, so reinfection is possible — if the risk is still part of your life, so are the precautions.
Where an untreated infection ends up
Scarring builds slowly: roughly one person in three reaches cirrhosis, and it usually takes twenty to thirty years. It goes faster in those who drink and smoke, who live with excess weight, type 2 diabetes, HIV or hepatitis B, and in those infected later in life.
Cirrhosis keeps quiet for a long time, then brings weakness, weight loss, stubborn itching, spider-like vessels on the skin and a yellow tinge to skin and eyes. At the late stage the liver stops coping: fluid gathers in the abdomen, the legs swell, thinking becomes muddled and widened veins in the gullet bleed. Liver cancer is a separate threat, which is why with cirrhosis an ultrasound scan is done every six months for life, even once the virus has been cured.
Call an ambulance (in Europe, the single number 112) if any of these appear:
- vomiting blood, or vomit that looks like coffee grounds;
- black, tarry stools;
- confusion, drowsiness, odd behaviour, a flapping tremor with the arms held out;
- an abdomen swelling rapidly together with fever and pain;
- jaundice that is deepening fast.
Everything else — new tiredness, itching, darker urine, swollen ankles — is a reason to be seen by a doctor the same day, not a reason to call an ambulance.
Beyond the liver
Hepatitis C also does damage outside the liver, and that is rarely talked about. The virus pushes the immune system into making proteins that settle in small blood vessels: hence the purple rash on the shins, the joint pain, the numbness and burning in the feet, and kidney damage with protein in the urine and swelling. Less often the virus is linked with certain lymphomas and with a skin disease in which sunlight raises fragile blisters on the backs of the hands. In many people it also worsens sensitivity to insulin.
The practical conclusion is simple: when a rash, a set of joints or a kidney problem has no explanation, a hepatitis C test deserves a place on the list. That is how the infection is quite often found, and after treatment most of these problems settle down.
What you can do yourself
While testing and treatment are under way, the liver's job can be made noticeably easier.
- Give up alcohol. Of everything here this matters most: alcohol and the virus wreck the liver side by side.
- Keep your weight in check, stop smoking and move regularly. All of it works against fatty liver disease, which speeds up scarring. Hepatitis C calls for no special diet; restricting salt and protein is needed only in advanced cirrhosis and only when a doctor says so.
- Discuss hepatitis A and hepatitis B vaccination with your doctor: on an already damaged liver those viruses are particularly dangerous.
- Take no medicines or supplements without your doctor's knowledge, herbal ones included, as some are toxic to the liver. For pain with a diseased liver the usual choice is paracetamol, at a dose agreed with your doctor.
- Keep razor, toothbrush and nail scissors to yourself, cover cuts with a plaster and clean up spilled blood with household bleach.
- Do not donate blood or organs, and tell your regular partner they should be tested.
Online consultation
Almost everything here can be sorted out remotely apart from emergencies. The doctor will work through whether there was a real risk of infection and whether a test is called for; will explain the difference between positive antibodies and active infection, which is where people take fright most often; and will read results you already have and say what comes next. If treatment is under way, a video appointment is a good place to check your regular medicines against the course, to talk over the side effects of the first days and to set the timing of the follow-up tests. The signs on the ambulance list are not assessed remotely — with those you call for help straight away.
This material is for information only and does not replace medical advice.
Consult with a doctor about Hepatitis C
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Hepatitis C
Discuss your symptoms and possible next steps for Hepatitis C with a doctor online.
