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Hepatitis C is a virus that can infect the liver. If left untreated, it can sometimes cause serious and potentially life-threatening damage to the liver over many years.
However, with modern treatments it's usually possible to cure the infection, and most people with it will have a normal life expectancy.
It's estimated around 215,000 people in the UK have hepatitis C.
You can become infected with it if you come into contact with the blood of an infected person.
Hepatitis C often doesn't have any noticeable symptoms until the liver has been significantly damaged. This means many people have the infection without realising it.
When symptoms do occur, they can be mistaken for another condition. Symptoms can include:
The only way to know for certain if these symptoms are caused by hepatitis C is to get tested.
Read more about the symptoms of hepatitis C.
The hepatitis C virus is usually spread through blood-to-blood contact.
Some ways the infection can be spread include:
In the UK, most hepatitis C infections occur in people who inject drugs or have injected them in the past. It's estimated around half of those who inject drugs have the infection.
Read more about the causes of hepatitis C.
Seek medical advice if you have persistent symptoms of hepatitis C or there's a risk you're infected, even if you don't have any symptoms. A blood test can be carried out to see if you have the infection.
Your local GP, sexual health clinic, genitourinary medicine (GUM) clinic or drug treatment service all offer testing for hepatitis C.
Early diagnosis and treatment can help prevent or limit any damage to your liver, as well as help ensure the infection isn't passed on to other people.
Read more about testing for hepatitis C.
Hepatitis C can be treated with medicines that stop the virus multiplying inside the body. These usually need to be taken for several weeks.
Up until recently, most people would have taken two main medications called pegylated interferon (a weekly injection) and ribavirin (a capsule or tablet). Tablet-only treatments are now available.
These new hepatitis C medications have been found to make treatment more effective, are easier to tolerate, and have shorter treatment courses.
They include simeprevir, sofosbuvir and daclatasvir. Using the latest medications, more than 90% of people with hepatitis C may be cured.
However, it's important to be aware that you won't be immune to the infection and should take steps to reduce your risk of becoming infected again.
If the infection is left untreated for many years, some people with hepatitis C will develop scarring of the liver (cirrhosis). Over time, this can cause the liver to stop working properly.
In severe cases, life-threatening problems such as liver failure – where the liver loses most or all of its functions – or liver cancer can eventually develop.
Treating hepatitis C as early as possible can help reduce the risk of these problems occurring.
Read more about the complications of hepatitis C.
There's no vaccine for hepatitis C, but there are ways to reduce your risk of becoming infected.
The risk of getting hepatitis C through sex is very low. However, it may be higher if blood is present, such as menstrual blood or from minor bleeding during anal sex.
Condoms aren't usually necessary to prevent hepatitis C for long-term heterosexual couples, but it's a good idea to use them when having anal sex or sex with a new partner.
Many people with hepatitis C don't have any symptoms and are unaware they have the infection. They may develop symptoms later on as their liver becomes increasingly damaged.
Only around one in every three or four people will have any symptoms during the first six months of a hepatitis C infection. This stage is known as acute hepatitis C.
If symptoms do develop, they usually occur a few weeks after infection. Symptoms may include:
Around one in every five people who experiences symptoms will also have yellowing of the eyes and skin. This is known as jaundice.
In around one in every four people infected with hepatitis C, the immune system will kill the virus within a few months and the person will have no further symptoms, unless they become infected again.
In the remaining cases, the virus persists inside the body for many years. This is known as chronic hepatitis.
The symptoms of long-term (chronic) hepatitis C can vary widely. In some people, symptoms may be barely noticeable. In others, they can have a significant impact on their quality of life.
The symptoms can also go away for long periods of time and then return.
Some of the most common problems experienced by people with chronic hepatitis C include:
If left untreated, the infection can eventually cause the liver to become scarred (cirrhosis). Signs of cirrhosis can include jaundice, vomiting blood, dark stools, and a build-up of fluid in the legs or abdomen.
Read more about the complications of hepatitis C.
See your GP if you persistently have any of the later symptoms above, or if they keep returning. They may recommend having a blood test that can check for hepatitis C.
Read more about diagnosing hepatitis C.
None of the symptoms above mean you definitely have hepatitis C, but it's important to get them checked out.
You should also speak to your GP about getting tested if there's a risk you're infected, even if you don't have any symptoms. This particularly includes people who inject drugs or have done so in the past.
Read about the causes of hepatitis C for more information about who's at risk of having the infection.
You can become infected with hepatitis C if you come into contact with the blood of an infected person.
Other bodily fluids can also contain the virus, but blood contains the highest level of it. Just a small trace of blood can cause an infection.
At room temperature, it's thought the virus may be able survive outside the body in patches of dried blood on surfaces for up to several weeks.
The main ways you can become infected with the hepatitis C virus are described below.
People who inject drugs, including illegal recreational drugs and performance-enhancing drugs such as anabolic steroids, are at the highest risk of becoming infected with hepatitis C.
Almost 90% of hepatitis C cases in the UK occur in people who inject drugs or have injected them in the past. It's estimated around half of the people in the UK who inject drugs have the infection.
The infection can be spread by sharing needles and associated equipment. Injecting yourself with just one contaminated needle may be enough to become infected.
It's also possible to get the infection by sharing other equipment used to prepare or take drugs – such as spoons, filters, pipes and straws – that have been contaminated with infected blood.
Hepatitis C may be transmitted during sex without using a condom (unprotected sex), although this risk is considered very low.
The risk of transmission through sex may be higher among men who have sex with men.
However, as the risk is very low for couples in a long-term relationship, many choose not to use a condom.
If your partner has hepatitis C, you should be tested for the condition.
Since September 1991, all blood donated in the UK is checked for the hepatitis C virus. If you received blood transfusions or blood products before this date, there's a small possibility you may have been infected with hepatitis C.
If you have a blood transfusion or medical or dental treatment overseas where medical equipment is not sterilised properly, you may become infected with hepatitis C. The virus can survive in traces of blood left on equipment.
There's a potential risk that hepatitis C may be passed on through sharing items such as toothbrushes, razors and scissors, as they can become contaminated with infected blood.
Equipment used by hairdressers, such as scissors and clippers, can pose a risk if it has been contaminated with infected blood and not sterilised or cleaned between customers. However, most salons operate to high standards, so this risk is low.
There is a risk that hepatitis C may be passed on by using tattooing or body piercing equipment that has not been properly sterilised. However, most tattoo and body piercing parlours in the UK operate to high standards and are regulated by law, so this risk is low.
There is a small chance that a mother who is infected with the hepatitis C virus will pass the infection on to her baby. This happens in around 5% of cases. It's not thought that the virus can be passed on by a mother to her baby in her breast milk.
There's a small – approximately 1 in 30 – risk of getting hepatitis C if your skin is accidentally punctured by a needle used by someone with hepatitis C.
Healthcare workers, nurses and laboratory technicians are at increased risk because they are in regular close contact with blood and bodily fluids that may contain blood.
If you think you may have been exposed to hepatitis C, taking a test will put your mind at rest or, if the test is positive, allow you to start treatment early.
You should consider getting tested for hepatitis C if you're worried you could have been infected or you fall into one of the groups at an increased risk of being infected.
Hepatitis C often has no symptoms, so you may still be infected if you feel healthy.
The following groups of people are at an increased risk of hepatitis C:
If you continue to engage in high-risk activities, such as injecting drugs frequently, regular testing may be recommended. Your doctor will be able to advise you about this.
Hepatitis C is usually diagnosed using two blood tests: the antibody test and the PCR test. The results usually come back within two weeks.
The antibody blood test determines whether you have ever been exposed to the hepatitis C virus by testing for the presence of antibodies to the virus. Antibodies are produced by your immune system to fight germs.
The test will not show a positive reaction for some months after infection because your body takes time to make these antibodies.
If the test is negative, but you have symptoms or you may have been exposed to hepatitis C, you may be advised to have the test again.
A positive test indicates that you have been infected at some stage. It doesn't necessarily mean you are currently infected, as you may have since cleared the virus from your body.
The only way to tell if you are currently infected is to have a second blood test, called a PCR test.
The PCR blood test checks if the virus is still present by detecting whether it is reproducing inside your body.
A positive test means your body has not fought off the virus and the infection has progressed to a long-term (chronic) stage.
If you have an active hepatitis C infection, you will be referred to a specialist for further tests to check if your liver has been damaged.
The tests you may have include:
The specialist can also talk to you about any treatment you may need.
Read more about treating hepatitis C.
Hepatitis C can often be treated successfully by taking medicines for several weeks.
If the infection is diagnosed in the early stages, known as acute hepatitis, treatment may not need to begin straight away.
Instead, you may have another blood test after a few months to see if your body fights off the virus.
If the infection continues for several months, known as chronic hepatitis, treatment will usually be recommended.
Treatment for hepatitis C involves:
You'll normally need to take medication for 8 to 48 weeks. The length of time will depend on the exact medicines you're taking and which version (strain) of the hepatitis C virus you have. Your doctor will advise you about this.
There are six main strains of the virus. In the UK, the most common strains are known as genotype 1 and genotype 3.
During treatment, you should have blood tests to check if your medication is working. If the test shows treatment is having little effect, it may be stopped as further treatment may be of little use.
There are some things you can do to help limit any damage to your liver and prevent the infection spreading to others.
These can include:
Read some FAQs about living with hepatitis C for more information.
Until relatively recently, treatment for chronic hepatitis C usually involved taking two main medicines:
These medications were frequently just taken together, but now there are new hepatitis C medications that have been shown to make treatment more effective.
In many cases, a combination of these newer medications may be taken without needing to take pegylated interferon and ribavirin as well.
Read more about all these medications below.
Pegylated interferon is usually taken as a weekly injection. You can be trained to inject yourself at home. It usually needs to be taken for up to 48 weeks, depending on your circumstances.
Ribavirin is available as capsules, tablets or an oral solution. It's normally taken twice a day with food. It needs to be taken alongside pegylated interferon for up to 48 weeks.
For more information, see the National Institute for Health and Care Excellence (NICE) guidelines on peginterferon alfa and ribavirin for the treatment of chronic hepatitis C.
There are also a number of newer medicines that are used to treat hepatitis C nowadays.
Some of these are taken alongside pegylated interferon and ribavirin, but in most cases they can be taken on their own or in combination with other new medicines.
These medications include:
These medications are taken as tablets once or twice a day for between 8 and 48 weeks, depending on the exact medicine you're taking, your hepatitis C genotype, and the severity of your condition.
These medicines are generally used to treat people with either genotype 1 or genotype 4 hepatitis C, although sometimes they're also used to treat people with other genotypes.
For more information, see the NICE guidelines on:
Research into even more effective medications is ongoing.
The effectiveness of treatment for hepatitis C can depend on the strain of the virus you have.
Genotype 1 used to be more challenging to treat and, until quite recently, less than half of people treated would be cured.
However, with the newer medications now available, the chances of a cure are much higher. Combinations of tablets now have a cure rate of more than 90%.
If the virus is successfully cleared with treatment, it's important to be aware that you're not immune to the infection. This means, for example, that you could become infected again if you continue to inject drugs after treatment.
If treatment doesn't work, it may be repeated, extended, or tried using a different combination of medicines.
Side effects of combination therapy involving interferon are quite common. The new tablet treatments have far fewer side effects and most people feel unaffected by them.
If your treatment involves interferon, side effects can include:
Hepatitis C medications can have unpredictable reactions when taken with other medicines or remedies. Always check with your specialist, GP or pharmacist before taking other types of medication.
Any side effects may improve with time as your body gets used to the medications. Tell your care team if any side effect is becoming particularly troublesome.
Coping with side effects can be challenging, but you should continue to take your medication as instructed. Missing doses may reduce the chances of you being cured.
The medications used to treat hepatitis C, particularly ribavirin, can be harmful to unborn babies and aren't normally used during pregnancy.
If you're pregnant when diagnosed with the infection, treatment will usually be delayed until you have given birth.
Otherwise, you'll be advised to use contraception throughout your treatment and may need to have regular pregnancy tests.
If you're a man taking ribavirin, you shouldn't have sex with a pregnant women unless you use a condom.
If your partner isn't pregnant, you should ensure contraception is used during the course of your treatment. Your partner may need to have regular pregnancy tests.
Some people with chronic hepatitis C decide against treatment. This may be because they:
Your care team can give you advice about this, but the final decision about treatment will be yours.
If you decide not to have treatment but then change your mind, you can ask to be treated at any point.
If left untreated, hepatitis C can sometimes cause scarring of the liver (cirrhosis). This can develop up to 20 years or more after you first become infected.
A number of things can increase your risk of getting cirrhosis, including:
Overall, up to one in every three people infected with hepatitis C will develop cirrhosis within 20 to 30 years. Some of these will then go on to develop liver failure or liver cancer.
If you have cirrhosis, the scarred tissue in your liver gradually replaces healthy tissue and prevents the liver from working properly.
There are usually few symptoms in the early stages. But as your liver loses its ability to function properly, you may experience:
Other than a liver transplant, there's no cure for cirrhosis. However, lifestyle measures and hepatitis C medications can help stop the condition getting worse.
Read more about treating cirrhosis.
In severe cases of cirrhosis, the liver loses most or all of its functions. This is known as liver failure or end stage liver disease.
Each year, around 1 in every 20 people with hepatitis-associated cirrhosis will develop liver failure.
Symptoms of liver failure include:
It's usually possible to live with liver failure for several years by taking medication. However, a liver transplant is currently the only way to cure the condition.
It's estimated that around 1 in every 20 people with hepatitis-associated cirrhosis will develop liver cancer each year.
Symptoms of liver cancer can include:
Unfortunately, it's not usually possible to cure liver cancer, especially in people with cirrhosis, although treatment can help control your symptoms and slow the spread of the cancer.
Read more about treating liver cancer.
Below are answers to some questions about living with hepatitis C, including questions about diet, the workplace, travelling and having a baby.
Drinking alcohol can increase the damage to your liver. If you have hepatitis C, you should try to cut out alcohol or limit your intake. If you need advice about this, ask your doctor or contact an alcohol self-help organisation.
If you're concerned that you're addicted to alcohol and are unable to stop drinking, contact your GP. Treatments are available to help you quit.
Read more about treating alcohol misuse.
As well as cutting out alcohol, it can help to:
This is because being overweight, smoking and having more than one type of hepatitis can increase the chances of your liver being damaged if you have hepatitis C.
You won't usually need to change to a special diet if you have hepatitis C, but you will need to make sure you have a generally healthy, balanced diet.
Your diet should include plenty of fruit and vegetables, starchy foods, fibre and protein. Cut down on fatty, fried and processed food. Read more about what a balanced diet means.
If your liver is badly damaged, however, your doctor may suggest limiting your intake of salt and protein to avoid putting too much strain on your liver. A hospital dietitian can advise you on what you can and cannot eat.
You can reduce the risk of passing hepatitis C on to other people by:
The risk of spreading hepatitis C through sex is low. However, the risk is increased if there is blood present, such as menstrual blood or during anal sex.
Condoms aren't usually necessary for long-term heterosexual couples, but it's a good idea to use them when having anal sex or sex with a new partner.
You don't have to tell your boss that you have hepatitis C, unless you're a healthcare worker.
However, if hepatitis C is affecting your performance at work and your employer knows about your condition, they may be obliged to make allowances for you, such as giving you leave of absence for going to the clinic. You may also be entitled to statutory sick pay to cover doctor appointments or time off work.
Therefore, you may want to consider telling your boss about your condition.
You can travel abroad if you have hepatitis C, but you should speak to your doctor in advance.
You may need to have vaccinations and special arrangements may need to be made to ensure you're able to transport and store your hepatitis C medication safely.
It might also be a good idea to take any documentation, such as details of blood tests or medical records, in case you need medical treatment abroad.
You can have a baby if you or your partner has hepatitis C, but there's a small risk (around 1 in 20) of hepatitis C passing from mother to baby.
There's also a small risk of the infection spreading to the unaffected partner when having unprotected sex, but this is very unlikely to happen.
Speak to your doctor for advice if you're planning to have a baby and you or your partner has hepatitis C.