Hepatitis C

Hepatitis C is a liver infection caused by the Hepatitis C Virus (HCV). Unlike Hepatitis B, HCV is spread primarily through blood-to-blood contact rather than sexual contact, though sexual transmission is possible.

Hepatitis C is often called a 'silent epidemic' because approximately 80% of people with HCV have no symptoms until the disease has been silently damaging the liver for years or decades. Chronic HCV is a leading cause of liver cirrhosis and liver cancer in India.

Most people with HCV have no symptoms for years or decades. When symptoms do appear, they reflect liver damage:

• Fatigue — often the first and most persistent symptom
• Jaundice — yellowing of the skin and eyes
• Dark urine and pale stools
• Abdominal pain and swelling
• Nausea and loss of appetite
• Easy bruising or bleeding (as liver function declines)

Advanced liver disease from untreated chronic HCV manifests as cirrhosis (liver scarring), liver failure, portal hypertension, and hepatocellular carcinoma.

HCV is primarily transmitted through blood-to-blood contact:

• Sharing needles, syringes, or drug preparation equipment — the most common route in India
• Unsterilised tattooing or piercing equipment
• Blood transfusions or organ transplants before 1992 (mandatory HCV screening introduced in India in 2001)
• Needlestick injuries in healthcare workers
• Mother-to-child at birth (~5% risk)
• Sexual transmission — possible, especially with blood exposure; lower risk than blood-contact routes

• Anti-HCV antibody test (ELISA) — screening test. Positive result means exposure to HCV. Window period: 8–11 weeks.
• HCV RNA PCR — confirms active infection by detecting viral RNA. Window period: 1–2 weeks after exposure. Used to confirm diagnosis after a positive antibody test.
• HCV genotype test — identifies which of 6 genotypes is present; guides treatment selection.
• Liver biopsy or fibroscan — assesses extent of liver damage.

Free HCV testing is available under India's National Viral Hepatitis Control Programme (NVHCP) at government health facilities.

Direct-acting antivirals (DAAs) have transformed Hepatitis C treatment:

• Sofosbuvir/velpatasvir (Epclusa) — 12 weeks; pan-genotypic (works for all HCV genotypes)
• Sofosbuvir/ledipasvir (Harvoni) — 8–12 weeks for genotypes 1, 4, 5, 6
• Treatment achieves SVR (Sustained Virological Response = cure) in 95-99% of patients
• Free DAA treatment available at government hospitals under NVHCP
• Generic DAA drugs manufactured in India are far cheaper than Western markets

• If you have ever shared needles, syringes, or drug equipment
• Blood transfusion before 2001 in India
• Unsterilised tattooing or piercing
• Healthcare worker with needlestick exposure
• Unexplained liver disease or persistently elevated liver enzymes
• Anyone born to an HCV-positive mother