Hepatitis C

Hepatitis C is an infection of the liver caused by the hepatitis C virus (HCV). It spreads mainly through blood-to-blood contact — historically through shared needles, and in the past through blood transfusions before screening began. A striking feature is how quiet it is: the acute infection usually causes few or no symptoms, so most people do not know when they were infected. In some people the immune system clears the virus on its own, but in the majority the infection becomes chronic (long-standing) and can persist silently for many years. Over this time, chronic hepatitis C slowly inflames and scars the liver in a proportion of people, which across decades can lead to cirrhosis and a raised risk of liver cancer — often without obvious warning until the damage is advanced. Because it is usually silent, hepatitis C is frequently found through screening or when routine blood tests show abnormal liver enzymes. It is diagnosed first with an antibody test, then confirmed with a viral-load (HCV RNA) test. The transformative development in recent years is that hepatitis C is now curable in the great majority of people with a short course (often 8–12 weeks) of well-tolerated direct-acting antiviral tablets — so finding it, even years after infection, usually leads to a cure and prevents future liver damage.

• Hepatitis C antibody (anti-HCV) — the screening test; positive means exposure at some point.
• HCV RNA (viral load) — confirms a current, active infection; distinguishes it from a past, cleared one.
• ALT and AST — liver enzymes; often mildly raised but can be normal even with active infection.
• HCV genotype — the viral strain, which used to guide treatment choice.
• Liver assessment (e.g. fibrosis scoring, imaging) — gauges any liver scarring.
• Tests for hepatitis B and HIV — often checked alongside, given shared routes.

• Very often none, for many years
• Tiredness, a common and sometimes the only symptom
• Poor appetite, nausea
• Discomfort under the right ribs
• Joint or muscle aches
• Acute infection (uncommonly noticed): a flu-like illness, sometimes jaundice
• In advanced disease with cirrhosis: jaundice, swelling, easy bruising and other signs