What is Hepatitis C ? See causes, symptoms, treatment, and prevention 2025.

Hepatitis C virus (HCV) is a bloodborne virus that causes liver inflammation. Many infected individuals show no symptoms at first, but without treatment, the infection can become chronic and lead to cirrhosis or liver cancer over time.

The good news is that modern oral antiviral treatments can cure over 95% of patients within a short duration, with minimal side effects—far better than past treatments.

This article explains everything you need to know about hepatitis C: from how it spreads, symptoms, testing, and treatment options to prevention strategies, based on the latest clinical guidelines from Thailand and international liver associations.

What is Hepatitis C?

Hepatitis C virus (HCV) is an enveloped, single-stranded RNA virus belonging to the Flaviviridae family. It causes liver inflammation in both acute and chronic stages, and may lead to serious complications such as liver cirrhosis or liver cancer if left untreated.

Most individuals infected with hepatitis C are asymptomatic in the early stages, which makes the infection difficult to detect. It is often discovered incidentally during routine blood tests, preoperative screenings, or blood donation assessments.

HCV is primarily transmitted through blood-to-blood contact. Common routes include sharing needles, receiving unscreened blood transfusions, or undergoing unsafe medical procedures. It is not spread through casual contact such as hugging, kissing, or sharing utensils in daily life.

How many genotypes does Hepatitis C have, and which is the most difficult to treat?

Hepatitis C virus (HCV) has six major genotypes, labeled Genotype 1 through 6. Each genotype differs in geographical distribution and treatment response.

• Genotype 1: The most common worldwide, including in Thailand. It responds well to direct-acting antiviral (DAA) treatment, although it was once considered difficult to treat with interferon-based therapy.
• Genotype 2 and 3: Found in certain parts of Asia and Southern Europe. Genotype 3 has been linked to higher rates of hepatic steatosis (fatty liver).
• Genotype 4: Predominantly found in North Africa and the Middle East.
• Genotype 5 and 6: Less common. Genotype 6 is found mainly in Southeast Asia, including northern Thailand.

Today, most patients can be treated effectively with newer DAA regimens that are pangenotypic, meaning they work across all major genotypes. Examples include sofosbuvir/velpatasvir and glecaprevir/pibrentasvir.

Nevertheless, genotyping may still be necessary in certain cases—especially in patients with cirrhosis, chronic kidney disease, or prior treatment failure—to help tailor the most appropriate treatment plan.

How is Hepatitis C different from other types of hepatitis?

There are several types of hepatitis viruses: A (HAV), B (HBV), C (HCV), D (HDV), and E (HEV). Each differs in transmission method, clinical course, and treatment approach.

• HAV and HEV: Spread through ingestion of contaminated food or water. They usually cause acute infections that resolve on their own and do not become chronic.
• HBV and HDV: Transmitted through blood and bodily fluids (e.g., sexual contact, childbirth, or needle sharing). They can cause chronic infections and are associated with long-term liver complications such as cirrhosis or hepatocellular carcinoma.
• HCV: Transmitted mainly through blood and is more likely to result in chronic infection. It often presents no symptoms in the early stages.

A key difference is that there is currently no vaccine for HCV, whereas effective vaccines are available for HAV and HBV. HCV is also one of the leading causes of liver transplantation worldwide due to its chronic progression.

How is hepatitis C transmitted? Can it spread through saliva?

Hepatitis C virus (HCV) is primarily transmitted through blood-to-blood contact. Infection occurs when blood from an infected person enters the bloodstream of another individual. Common modes of transmission include:

• Sharing needles or injection equipment, especially among people who inject drugs
• Tattooing, body piercing, or dental procedures using unsterilized instruments
• Receiving unscreened blood transfusions or blood products (although current screening practices are highly effective)
• Accidental exposure to infected blood, such as needle-stick injuries or providing care without protective equipment

Sexual transmission is possible, though less common, and is more likely in the presence of open sores, high-risk behaviors, or co-infection with HIV.

HCV is not transmitted through saliva, tears, sweat, food, or casual contact. Everyday interactions such as hugging, kissing, or sharing meals pose no risk unless blood is involved.

Risk behaviors associated with hepatitis C infection

Although hepatitis C is primarily transmitted through blood exposure, several behaviors can significantly increase the risk of acquiring the virus, often unknowingly:

• Sharing injection needles or syringes, especially among people who inject drugs
• Tattooing, body piercing, or dental work in facilities with poor sterilization practices
• Receiving blood transfusions or organ transplants without proper screening (rare with current protocols)
• Unprotected sex, especially when blood is involved or in individuals co-infected with HIV
• Direct contact with infected blood, such as during wound care or first aid without protection
• Mother-to-child transmission during childbirth (less common than other transmission routes)

Casual contact—such as hugging, sharing utensils, or living in the same household—does not pose a risk for hepatitis C infection.

What are the symptoms of hepatitis C? (Acute vs. chronic)

Most people infected with hepatitis C have no noticeable symptoms in the early stages, making the infection difficult to detect. Symptoms can be classified into two phases:

Acute phase (within 6 months of infection)

About 20–30% of patients may experience:

• Fatigue, loss of appetite
• Nausea, abdominal discomfort
• Dark urine, pale stool
• Yellowing of the skin or eyes (jaundice)

However, over 70% of individuals show no symptoms or only mild, nonspecific signs.

Chronic phase (after 6 months)

If the infection persists beyond six months without spontaneous clearance, it becomes chronic. Symptoms may take years or even decades to appear:

• Persistent fatigue, joint pain
• Skin itching or rashes
• Memory issues, depression
• Liver cirrhosis or liver cancer in advanced stages

Some individuals with chronic infection remain asymptomatic until significant liver damage has occurred.

Complications of hepatitis C: cirrhosis, liver cancer, and more

Without timely diagnosis and proper treatment, chronic hepatitis C infection can lead to serious complications affecting both the liver and other organ systems.

1. Cirrhosis

This is a condition where healthy liver tissue is progressively replaced by scar tissue (fibrosis), impairing liver function. Common signs include:

• Abdominal fluid accumulation (ascites), leg swelling
• Esophageal varices (swollen veins that may bleed)
• Easy bruising, low platelet counts
• Mental confusion or disorientation (hepatic encephalopathy)

2. Liver cancer (Hepatocellular Carcinoma – HCC)

Chronic hepatitis C is a major risk factor for liver cancer, especially in patients with cirrhosis. Those left untreated have a significantly increased lifetime risk of developing HCC.

3. Extrahepatic manifestations

Beyond the liver, HCV can be linked to systemic issues such as:

• Certain forms of chronic kidney disease
• Vasculitis (inflammation of blood vessels)
• Insulin resistance or type 2 diabetes

Who should get tested for hepatitis C?

Because hepatitis C is often asymptomatic in its early stages, screening plays a critical role in identifying undiagnosed infections.
Current guidelines from the World Health Organization (WHO), U.S. Centers for Disease Control and Prevention (CDC), and various liver societies recommend testing the following groups:

People who should be tested at least once in their lifetime

• Those born between 1965 and 1980
• Adults aged 18 years and older, regardless of risk factors
• Individuals who have never been tested for HCV

High-risk groups who may require repeat or ongoing testing

• People who currently use or have ever injected drugs
• Recipients of blood transfusions or organ transplants before 1992
• Patients with abnormal liver enzymes or known liver disease
• Individuals co-infected with HIV or HBV
• Incarcerated individuals, or those with tattoos/piercings from unregulated settings
• Pregnant women (one-time screening is recommended in some guidelines)

HCV testing is simple and typically requires only a single blood draw. If the result is positive, further testing will confirm the infection and guide treatment decisions.

How is hepatitis C diagnosed? (Anti-HCV, HCV RNA, PCR)

Diagnosing hepatitis C involves a two-step process: initial screening and confirmation of active infection

1. Anti-HCV test

This test detects antibodies to the hepatitis C virus in the blood. A positive result indicates that the person has been exposed to HCV, but does not confirm whether the infection is still active.

2. HCV RNA or PCR test

If Anti-HCV is positive, a follow-up test—either HCV RNA or PCR—is needed to check for the actual presence of the virus.
Detection of HCV RNA confirms an active (ongoing) infection.

Summary of tests

If active infection is confirmed, additional assessments such as liver enzymes (ALT, AST), FibroScan, and treatment planning will follow.

Do you need to fast before hepatitis C testing?

For most hepatitis C tests, such as Anti-HCV or HCV RNA (PCR), fasting is not required. These are standard blood tests that are not affected by food or drink.

However, if your doctor has ordered additional tests—such as fasting blood sugar, cholesterol, or a full liver panel— you may be instructed to fast for 8 to 12 hours beforehand.

The best approach is to check with your healthcare provider or lab ahead of time to confirm any pre-test instructions.

What is FibroScan and how does it detect liver stiffness?

FibroScan, also known as Transient Elastography, is a non-invasive technology that uses low-frequency sound waves to measure liver stiffness. It helps assess the extent of liver fibrosis or cirrhosis without the need for a traditional liver biopsy.

How it works

The device sends sound waves through the skin over the right upper abdomen. The speed at which the waves bounce back is measured—faster waves indicate stiffer (more fibrotic) liver tissue. Results are shown in kilopascals (kPa).

Advantages of FibroScan

• Painless and non-invasive; no needles or anesthesia required
• Quick—typically takes 5 to 10 minutes
• Ideal for long-term monitoring of chronic liver disease

When is it used?

• Chronic hepatitis C patients, to evaluate liver damage before treatment
• Post-treatment follow-up, to monitor for complications like liver cancer
• Other liver conditions, such as hepatitis B or fatty liver disease

Treating hepatitis C: Interferon vs modern DAAs

Historically, hepatitis C treatment involved injectable interferon combined with oral ribavirin. This approach had limited effectiveness, significant side effects, and required long durations (6–12 months).

Today, treatment has shifted to Direct-Acting Antivirals (DAAs)—oral medications that directly inhibit the virus, delivering superior outcomes.

Comparison: Interferon vs. DAA

Modern DAAs are now the standard of care, especially pangenotypic options like sofosbuvir/velpatasvir or glecaprevir/pibrentasvir—effective and convenient for a broad range of patients.

What types of DAAs are there and how do they work?

Direct-Acting Antivirals (DAAs) are medications that target specific proteins or enzymes critical to the hepatitis C virus lifecycle. They disrupt the virus’s ability to replicate and produce new viral particles.

DAA drug classes by mechanism

1. NS5A inhibitors: Block the NS5A protein involved in viral replication
   • Examples: ledipasvir, velpatasvir, pibrentasvir
2. NS5B polymerase inhibitors: Inhibit RNA polymerase needed for viral genome synthesis
   • Example: sofosbuvir
3. NS3/4A protease inhibitors: Inhibit viral enzymes used to process viral proteins
   • Examples: glecaprevir, grazoprevir

Commonly used pangenotypic regimens

• Sofosbuvir + Velpatasvir (brand name: Epclusa)
• Glecaprevir + Pibrentasvir (brand name: Mavyret)

These combinations are effective across all major HCV genotypes (1–6) and achieve cure rates above 95%.

How long does hepatitis C treatment take?

Treatment duration for hepatitis C using Direct-Acting Antivirals (DAAs) typically ranges from 8 to 12 weeks, depending on factors such as:

• HCV genotype
• Liver condition (presence of cirrhosis)
• Prior treatment history
• Type of DAA regimen used

General treatment guidelines

Certain cases—such as co-infections or special populations—may require adjustments in regimen and duration. Final decisions are based on guidelines from ThaiLiver, AASLD, or EASL.

What is SVR (Sustained Virologic Response)?

SVR, or Sustained Virologic Response, is the primary goal of hepatitis C treatment. It is defined as having no detectable HCV RNA in the blood 12 weeks after completing antiviral therapy—indicating a clinical cure with minimal risk of relapse.

Why is SVR important?

• Achieving SVR12 or SVR24 is strongly associated with long-term viral clearance and a significant reduction in complications such as cirrhosis and liver cancer
• SVR is the benchmark for evaluating the effectiveness of different treatment regimens
• Once SVR is achieved, no further treatment is needed—unless reinfection occurs

Today’s newer DAAs allow 95–99% of patients to achieve SVR, with minimal side effects and without injections.

How should patients be monitored after treatment?

Even after achieving viral clearance (SVR), post-treatment follow-up remains important to prevent complications and detect possible reinfection—especially in high-risk individuals.

Recommended follow-up steps

1. Repeat HCV RNA testing at 12 weeks post-treatment to confirm SVR
2. Monitor liver function tests (ALT, AST, albumin, INR) every 6–12 months if cirrhosis is present
3. Abdominal ultrasound with AFP (liver cancer marker) every 6 months in patients with a history of cirrhosis
4. No ongoing monitoring is needed for non-cirrhotic patients unless new risk factors arise

Special groups

• Patients with compensated cirrhosis should undergo lifelong surveillance for liver cancer
• Co-infected patients (HIV or HBV) require multidisciplinary care with specialists

Where should you go for hepatitis C treatment?

Patients diagnosed with hepatitis C should seek care at facilities equipped with specialists in gastroenterology or hepatology, and access to standardized lab testing and follow-up systems.

Recommended facility types for HCV treatment

• Public tertiary hospitals (e.g., university or provincial hospitals) Often covered by national health schemes (e.g., universal coverage, social security)
• Private hospitals with liver or GI clinics
• Liver-specific clinics offering initial diagnosis and treatment per national guidelines

How to choose the right facility?

• Presence of experienced liver specialists
• Access to modern DAA medications
• Comprehensive follow-up services including liver ultrasound
• For insurance-based care, verify if the hospital is within your coverage network

How much does hepatitis C treatment cost?

The cost of hepatitis C treatment varies depending on the healthcare facility, type of medication, and the patient’s insurance coverage.
In general, expenses fall into three main categories:

1. Medication costs (DAAs)

• Modern DAAs like sofosbuvir/velpatasvir or glecaprevir/pibrentasvir In public hospitals, the cost may be fully covered if criteria are met
• In private hospitals, the full course typically ranges from 30,000–70,000 THB (8–12 weeks)

2. Diagnostic and follow-up tests

• Includes HCV RNA, liver function tests, FibroScan, and routine labs Estimated at 3,000–10,000 THB, depending on the tests performed

3. Other medical service fees

• Doctor consultations, registration fees, ultrasound exams, etc. Typically 500–2,000 THB per visit

Note:

• Patients covered by Thailand’s Universal Coverage (UC) or Social Security (SSO) may receive treatment free of charge
• Always check with your hospital about eligibility and required documentation

How can hepatitis C be prevented?

Although there is currently no vaccine for hepatitis C, the infection can be prevented by avoiding high-risk behaviors and practicing strict hygiene measures.

Hepatitis C prevention tips

• Avoid sharing needles or injection equipment
• Use personal grooming items (e.g., razors, nail tools) individually
• Choose licensed facilities for dental work, tattoos, and piercings
• Use condoms during high-risk sexual activity
• Avoid contact with blood or contaminated sharp objects
• Healthcare workers should always wear protective gear

For individuals already infected:

• Do not donate blood or organs
• Inform healthcare providers before any procedure
• Avoid sharing sharp or personal hygiene items with others

Is there a vaccine for hepatitis C?

Currently, there is no approved vaccine for hepatitis C available for human use. Despite ongoing research, no candidate has yet demonstrated sufficient efficacy in clinical trials.

Why is HCV vaccine development challenging?

• HCV has multiple genotypes and subtypes (1–6 and beyond)
• The virus mutates rapidly, making immune targeting difficult
• The immune response to HCV is not fully understood, complicating vaccine design

What should you do instead?

• Avoid high-risk behaviors such as sharing needles or contact with blood
• Get tested promptly if you believe you’re at risk
• If diagnosed, start treatment early—modern therapies offer a clinical cure in most cases

Should people with hepatitis C get vaccinated for hepatitis A and B?

Although there is no vaccine for hepatitis C, it is recommended that individuals with HCV receive vaccines for hepatitis A (HAV) and hepatitis B (HBV).
Co-infection with HAV or HBV can worsen liver inflammation and significantly increase the risk of complications like acute liver failure.

Why vaccinate against HAV and HBV?

• HCV-infected individuals are more vulnerable to severe hepatitis if exposed to HAV or HBV
• HAV and HBV are preventable through safe and effective vaccines
• Preventing additional liver infections reduces long-term health risks

Recommendations:

• If never vaccinated, check antibody levels before immunization
• Vaccines may be given separately or as a combined formulation (e.g., Twinrix)
• A full vaccine course offers long-lasting immunity

How should hepatitis C be managed during pregnancy?

Pregnant women infected with hepatitis C should be co-managed by an obstetrician and a liver specialist. While HCV typically does not harm fetal development, there is an estimated 5–6% risk of mother-to-child transmission.

Care guidelines for HCV-positive pregnant women

• HCV RNA testing is recommended to assess active infection
• DAAs are not currently recommended during pregnancy due to limited safety data
• Counsel on transmission prevention (e.g., no sharing of personal sharp items)
• Cesarean delivery is not routinely indicated unless for obstetric reasons
• Infants should be tested for Anti-HCV at age ≥ 18 months
• If the child is infected, appropriate follow-up and treatment planning is essential

Does hepatitis C in children and adolescents require different care?

Hepatitis C in children and adolescents is less common than in adults but may result from vertical transmission or past blood exposure. While general care principles are similar to adults, there are important differences in medication choice and monitoring.

Current guidelines for pediatric HCV care

• HCV RNA testing is recommended after age 3 for suspected congenital infections
• Chronic cases should undergo liver evaluation and treatment planning
  
  
• Oral DAA regimens like sofosbuvir/velpatasvir are now approved for children aged ≥3 years in many countries, including Thailand
• Developmental monitoring should accompany medical management

Important notes:

• Avoid using interferon or ribavirin without specialist supervision
• Children should be managed by a pediatric gastroenterologist or hepatologist

Can you get hepatitis C again after being cured?

Although Direct-Acting Antivirals (DAAs) can achieve a clinical cure (SVR),
clearing hepatitis C once does not provide lifelong immunity.
Therefore, reinfection is possible if the individual is exposed to the virus again.

When can reinfection occur?

• Resuming high-risk behaviors like sharing needles or exposure to infected blood
• Unprotected sex with an HCV-positive partner
• Receiving blood or organ transplants from an undiagnosed infected donor

How to prevent reinfection?

• Continue avoiding risky behaviors even after cure
• Attend regular follow-ups, especially for high-risk individuals
• Get retested with HCV RNA promptly if reinfection is suspected

Summary: How dangerous is hepatitis C?

Hepatitis C virus (HCV) often causes no symptoms in its early stages, leading many individuals to remain undiagnosed. Without treatment, it can progress to chronic infection and cause severe complications such as cirrhosis, liver cancer, and liver failure.

Why is hepatitis C considered dangerous?

• Up to 20–30% of chronic HCV patients develop cirrhosis over time
• HCV-related cirrhosis is a leading cause of hepatocellular carcinoma (HCC)
• Transmission occurs via blood, and no preventive vaccine is currently available

On the positive side…

• Modern antiviral treatments achieve SVR rates > 95%
• Early detection and timely therapy offer a high chance of cure
• Prevention and risk-based screening help reduce community-wide transmission

FAQ: Hepatitis C

Q: Can hepatitis C spread through kissing or sharing food?

A: No. HCV is not transmitted via saliva or shared utensils. It spreads only through direct blood-to-blood contact.

Q: Can someone with hepatitis C donate blood or organs?

A: No. Individuals with current or past HCV infection should not donate blood or organs to prevent transmission.

Q: What follow-up is needed after treatment?

A: Repeat HCV RNA testing at 12 weeks post-treatment to confirm SVR. If cirrhosis is present, continue ultrasound and AFP every 6 months.

Q: Are household members at risk of infection?

A: Risk is very low without direct blood contact. Still, avoid sharing sharp personal items like nail clippers or razors.

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