Hepatitis C: frequently asked questions

Hepatitis C is a liver disease caused by the hepatitis C virus, which spreads through contact with blood. For years it was a hard infection to treat, but that has changed completely: hepatitis C is now curable in more than 95% of cases with an 8 to 12 week course of pills, well tolerated and without the old interferon injections.

If you have been told you have hepatitis C, or you fear you may have been exposed, this guide answers the most common questions: how it spreads and how it does not, whether it is curable, how it is diagnosed and what to do in special situations such as pregnancy. The underlying message is reassuring: diagnosed in time, hepatitis C is cured and liver damage is avoided.

What is hepatitis C?

Hepatitis C is a liver infection caused by the hepatitis C virus (HCV). The virus settles in the liver cells and causes inflammation. In many people the body cannot clear it on its own and the infection becomes chronic, meaning it lasts for years.

The problem is that this sustained inflammation, over one or two decades, can lead to fibrosis (scarring of the liver), cirrhosis and, in some cases, liver cancer. That is why it is worth diagnosing and treating it before that damage appears.

How is hepatitis C spread?

Hepatitis C is transmitted through contact with infected blood. The most common routes today are:

• Sharing needles, syringes or other equipment to inject drugs.
• Sharing items that may carry traces of blood, such as razors or nail clippers.
• Tattoos or piercings done with unsterilized instruments.
• Accidental needlestick injuries in health care settings.
• Blood transfusions or transplants received before 1996 in Chile, when donated blood was not yet screened.

Sexual transmission is uncommon in stable heterosexual couples, but it increases with practices that involve contact with blood. Transmission from mother to child during pregnancy is possible, though infrequent.

How is hepatitis C NOT spread?

This is one of the fears that most distresses families. Hepatitis C is not transmitted through everyday contact. You do not catch it from:

• Shaking hands, hugging or kissing someone with hepatitis C.
• Sharing the same space, the table or cutlery.
• Sharing plates, glasses or cooking for the family.
• Coughing or sneezing.
• Breastfeeding, except in specific situations (see below).

A person with hepatitis C can lead a normal family and social life. There is no need to isolate them or separate their dishes.

Is hepatitis C curable?

Yes. This is the most important development of recent years. Hepatitis C is cured with direct-acting antivirals (DAAs), pills that attack the virus directly. Current treatments achieve a cure in more than 95% of people, and in many studies the figure exceeds 98%.

The cure is called a sustained virologic response: it means that, after finishing treatment, the virus is no longer detectable in the blood. In practice it is the same as being free of hepatitis C. Treatment usually lasts 8 to 12 weeks, is taken by mouth and has few side effects. Current regimens are pangenotypic, meaning they work for nearly all genotypes of the virus, such as sofosbuvir with velpatasvir or glecaprevir with pibrentasvir.

One point should be clear: interferon and ribavirin are no longer used as routine treatment. Those older therapies were long, given by injection and had many side effects. If you were told about “injections for a year,” that information is now outdated.

How is hepatitis C diagnosed?

The diagnosis is made with blood tests, in two steps:

1. Anti-HCV antibodies. This is the screening test. A positive result means you came into contact with the virus at some point, but on its own it does not tell whether the infection is still active.
2. Viral load (HCV RNA PCR). This confirms whether the virus is present and active in the blood. If the viral load is positive, there is a current infection and treatment is warranted. If it is negative, the infection has already resolved.

With current treatments, it is usually no longer necessary to know the genotype, because pangenotypic regimens work similarly across all of them. Nor is a liver biopsy needed to decide on treatment: the degree of liver damage is estimated with blood tests and with elastography (a special ultrasound that measures liver stiffness).

Who should be tested?

Current guidelines recommend universal screening: that every adult be tested for hepatitis C at least once in their lifetime, even without symptoms or risk factors. This is because the infection is often silent and many people do not know they have it.

Testing is especially important, and should be repeated, for anyone who:

• Has ever injected drugs, even a single time.
• Received transfusions or transplants before 1996.
• Is on dialysis.
• Has HIV or another cause of a weakened immune system.
• Has unexplained elevated liver enzymes.
• Was exposed to the blood of a person with hepatitis C.

What are the symptoms?

Most people with hepatitis C have no symptoms for years, and that is precisely why so many infections go unnoticed. When there are complaints, they tend to be nonspecific: fatigue, loss of appetite or mild discomfort in the right side of the abdomen.

Symptoms of advanced liver disease appear only when significant damage (cirrhosis) is already present and are the exception, not the rule:

• Yellowing of the skin and eyes (jaundice).
• Dark urine (choluria).
• Fluid buildup in the abdomen (ascites) or in the legs.
• Vomiting blood from esophageal varices.
• Confusion or drowsiness (hepatic encephalopathy).

The absence of symptoms does not mean the infection is harmless. That is why the diagnosis rests on tests, not on how a person feels.

I have hepatitis C and I am pregnant, what should I know?

The risk that a mother with hepatitis C passes the virus to her child during pregnancy is low, around 5%, and it rises if there is also HIV infection. There is currently no vaccine or treatment given during pregnancy to prevent that transmission, because direct-acting antivirals are not yet used routinely in pregnancy.

The recommended approach is to treat hepatitis C before a pregnancy when possible, or after delivery. Vaginal birth is not contraindicated by hepatitis C. Breastfeeding is considered safe, except when the mother has cracked or bleeding nipples, a situation in which it is best paused temporarily. The newborn is checked later on to confirm whether or not they acquired the virus.

How is hepatitis C treated in Chile?

In Chile hepatitis C is included in state coverage. Treatment with direct-acting antivirals is part of the guaranteed benefits, in both FONASA and private insurers (isapres), and access to these medicines through the public system has been expanding. The goal, aligned with the WHO target, is to eliminate hepatitis C as a public health threat.

Before and during treatment it helps to follow some general recommendations:

• Avoid alcohol, which speeds up liver damage.
• Do not take medications or supplements without checking, because some interact with the antivirals.
• Keep a normal, balanced diet.
• Get vaccinated against hepatitis A and hepatitis B if you are not already immune.

People who have already developed cirrhosis should still be treated, and then keep regular check-ups, because even after the virus is cured a risk of liver cancer remains that is worth monitoring.

I was cured of hepatitis C, can I get it again?

Yes. Being cured of hepatitis C does not leave immunity. The cure clears the virus you had, but it does not protect against a new infection if you are exposed to infected blood again. That is why, after a cure, the same precautions apply: do not share needles or items that may carry blood, and insist on sterile equipment for tattoos and procedures.

In people with ongoing exposure, such as those who inject drugs, reinfection is possible, and in those cases repeat testing is recommended periodically. Getting infected again is not a failure: if it happens, it can be treated once more.

How can I protect my family?

Daily life together is safe, but a few simple precautions help avoid contact with blood:

• Do not share razors, nail clippers or toothbrushes.
• Cover cuts or wounds with a dressing.
• Clean up blood spills with gloves and disinfectant.
• Choose tattoo and piercing studios that use disposable equipment.
• If you have active hepatitis C, do not donate blood or organs.

The best way to protect others, in any case, is to get treated: a cured person no longer transmits the virus.

What should I do if I think I was exposed to the virus?

See your doctor and get the anti-HCV antibody test. If it is positive, it is confirmed with the viral load. Do not wait for symptoms, because hepatitis C is usually silent and an early diagnosis allows a cure before it damages the liver. If the result is negative but the exposure was recent, your doctor may recommend repeating the test a few weeks later.

Points to remember

• Hepatitis C is a liver infection spread through contact with blood.
• It is not spread by everyday contact or by sharing the table.
• It is now curable in more than 95% of cases with pills over 8 to 12 weeks.
• Interferon and ribavirin are no longer used as routine treatment.
• It is diagnosed with anti-HCV antibodies and confirmed with the viral load.
• Every adult is advised to be tested at least once in their lifetime.
• A cure does not leave immunity: reinfection is possible with new exposure.

See also

• Hepatitis C
• Cirrhosis
• Liver transplant
• Nutrition and the liver