Hepatitis C

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 easily possible to cure the infection and most people with it will have a normal life expectancy.

It's estimated that 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.

Symptoms of hepatitis C

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:

• flu-like symptoms, such as muscle aches and a high temperature (fever)
• feeling tired all the time
• loss of appetite
• abdominal pain
• feeling and being sick

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.

How do you get hepatitis C?

The hepatitis C virus is usually spread through blood-to-blood contact.

Some ways the infection can be spread include:

• sharing unsterilised needles – particularly needles used to inject recreational drugs
• sharing razors or toothbrushes
• from a pregnant woman to her unborn baby
• through unprotected sex – although this is very rare
• if you had a blood transfusion in Scotland before September 1991, for example after a traffic accident or during childbirth, you may have been exposed to unscreened donor blood that potentially carried hepatitis C – all donor blood in Scotland has been screened for hepatitis C since September 1991
• if you have a blood transfusion, medical or dental treatment overseas where medical equipment is not sterilised properly, as the virus can survive in traces of blood left on equipment; this also applies to other potential blood to blood transmission routes such as barbers and tattoo parlours

In the UK, most hepatitis C infections occur in people who inject drugs or have injected them in the past. It's estimated that around half of those who inject drugs have the infection.

Read more about the causes of hepatitis C.

Getting tested for 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 GP, sexual health clinic, GUM (genitourinary medicine) clinic or drug treatment service all offer testing for hepatitis C. Testing is available at most substance use recovery services and also a variety of third sector services.

Early diagnosis and treatment can help prevent or limit any damage to your liver and help ensure the infection isn't passed on to other people.

Read more about testing for hepatitis C.

Treatments for hepatitis C

Hepatitis C can be treated with a single, or combination of, medicines that stop the virus multiplying inside the body. Traditionally hepatitis C was treated with interferon (an injection) and ribavirin. New, all-oral medicines are now available for everyone and treatment is usually only for 8 to 12 weeks.

Using these latest medications, around 95% or more of people with hepatitis C will 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.

Read more about treating hepatitis C and living with hepatitis C.

Complications of hepatitis C

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.

Preventing hepatitis C

There's no vaccine for hepatitis C, but there are ways to reduce your risk of becoming infected, such as:

• not sharing any drug-injecting equipment with other people – including needles and other equipment such as syringes, spoons and filters
• not sharing razors or toothbrushes that might be contaminated with blood

The risk of getting hepatitis C through vaginal 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 very 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.

Early symptoms

Only around 1 in every 3 or 4 people will have any symptoms during the first 6 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:

• a high temperature of 38C (100.4F) or above
• tiredness
• loss of appetite
• abdominal pains
• feeling and being sick

Around 1 in every 5 people who experiences symptoms will also have yellowing of the eyes and skin. This is known as jaundice.

In around 1 in every 4 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.

Later symptoms

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 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:

• feeling tired all the time
• joint and muscle aches and pain
• feeling sick
• problems with short-term memory, concentration and completing complex mental tasks such as mental arithmetic – many people describe this as "brain fog"
• mood swings
• depression or anxiety
• indigestion or bloating
• itchy skin
• abdominal pain

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.

When to seek medical advice

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.

Injecting drugs

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 that 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.

Less common causes

Unprotected sex

Hepatitis C may be transmitted during unprotected sex (sex without using a condom), although this risk is considered very low.

The risk of transmission through sex may be higher among men who have sex with men. The risk is also increased if there are genital sores or ulcers from a sexually transmitted infection, or if either person also has HIV.

The best way to prevent transmission of hepatitis C through sex is to use a male condom or female condom. 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.

Blood donations before September 1991

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.

Blood transfusions and treatment abroad

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.

Sharing toothbrushes, scissors and razors

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 been sterilised or cleaned between customers. However, most salons operate to high standards, so this risk is low.

Tattooing and body piercing

There is a risk that hepatitis C may be passed on through 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.

Mother to child

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.

Needlestick injury

There's a small (approximately one 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.

GP surgeries, sexual health clinics, GUM (genitourinary medicine) clinics or drug treatment services all offer testing for hepatitis C. A variety of sexual health and social support third sector services also provide testing.

Who should get tested?

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:

• ex-drug users and current drug users, particularly users of injected drugs
• people who received blood transfusions before September 1991
• recipients of organ or tissue transplants before 1992
• people who have lived or had medical treatment in an area where hepatitis C is common – high risk areas include North Africa, the Middle East and Central and East Asia
• babies and children whose mothers have hepatitis C
• anyone accidentally exposed to the virus, such as health workers
• people who have received a tattoo or piercing where equipment may not have been properly sterilised
• sexual partners of people with 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.

Testing for hepatitis C

Hepatitis C is usually diagnosed using 2 blood tests: the antibody test and the PCR test. These can be as part of a routine blood test or are often combined as a dried blood spot test. The dried blood spot test is similar to a blood sugar test in pricking the finger to get a blood spot that is put on a testing card. This is then sent to a laboratory to be tested.

Another similar test is an antigen test, which if used can often get the results back in 90 minutes. This is very expensive and not many services have access to the machine needed.

The antibody test

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 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 that your body has not fought off the virus, and the infection has progressed to a chronic (long-term) stage.

Further tests

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:

• blood tests – these measure certain enzymes and proteins in your bloodstream that indicate whether your liver is damaged or inflamed
• ultrasound scans – where sound waves are used to test how stiff your liver is (stiffness suggests the liver is scarred)

The specialist can also talk to you about any treatment you may need. Read more about treating hepatitis C.

Hepatitis C can be treated with a single, or combination of, medicines that stop the virus multiplying inside the body. Traditionally hepatitis C was treated with interferon (an injection) and ribavirin. New, all-oral medicines are now available for everyone and treatment is usually only for 8 to 12 weeks.

Using these latest medications, around 95% or more of people with hepatitis C will 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 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.

Your treatment plan

Treatment for hepatitis C involves:

• making lifestyle changes to help prevent further damage to your liver and reduce the risk of spreading the infection
• taking medications to fight the virus

You'll normally need to take medication for 8 to 12 weeks. This 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 6 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. Using these latest medications, around 95% or more of people with hepatitis C will be cured.

Lifestyle measures

There are some things you can do to help limit or even undo any damage to your liver and before you start treatment you can prevent the infection spreading to others. These can include:

• eating a healthy and balanced diet
• exercising regularly
• cutting out alcohol or limiting your intake
• stopping smoking
• keeping personal items, such as toothbrushes or razors, for your own use
• not sharing any needles or syringes with others

Read some FAQs about living with hepatitis C for more information.

Hepatitis C medications

Until relatively recently, treatment for chronic hepatitis C usually involved taking 2 main medicines:

• pegylated interferon
• ribavirin

Newer medications

There are now a number of new medicines, called direct acting antivirals (DAA) that are always used to treat hepatitis C . DAA tablets are the safest and most effective medicines for treating hepatitis C.

These medications are taken as tablets once or twice a day, for between eight and 16 weeks, depending on the exact medicine you're taking, your hepatitis C genotype and the severity of your condition.

Some types of hepatitis C can be treated using more than 1 type of DAA.

NHS-approved hepatitis C medicines include:

• sofosbuvir
• a combination of ledipasvir and sofosbuvir
• a combination of ombitasvir, paritaprevir and ritonavir, taken with or without dasabuvir
• a combination of sofosbuvir and velpatasvir
• a combination of sofosbuvir, velpatasvir and voxilaprevir
• a combination of glecaprevir and pibrentasvir
• ribavarin

For more information on a particular drug, see the NICE guidelines on treating chronic hepatitis C

How effective is treatment?

The new medications now available cure more than 95% of all infections, across all genotypes and levels of disease progression.

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 treatment

Treatments with direct acting antivirals (DAAs) have very few side effects. Most people find DAA tablets very easy to take.

You may feel a little sick and have trouble sleeping to begin with, but this should soon settle down.

Your nurse or doctor should be able to suggest things to help ease any discomfort.

You need to complete the full course of treatment to ensure you clear the hepatitis C virus from your body.

If you have any problems with your medicines, speak to your doctor or nurse straight away.

Side effects for each type of treatment can vary from person to person.

For a very small number of people, more severe side effects from hepatitis C treatments may include:

• depression
• skin irritation
• anxiety
• problems sleeping (insomnia)
• anorexia
• tiredness caused by anaemia
• hair loss
• aggressive behaviour

Hepatitis C medications may 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.

Treatment during pregnancy

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 you 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 and your partner may need to have regular pregnancy tests.

Deciding against treatment

Some people with chronic hepatitis C decide against treatment. This may be because they:

• don't have any symptoms
• are willing to live with the risk of cirrhosis at a later date
• don't feel the potential benefits of treatment outweigh the side effects treatment can cause

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:

• drinking alcohol
• having type 2 diabetes
• getting hepatitis C at an older age
• having HIV or another type of hepatitis, such as hepatitis B

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.

Cirrhosis

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:

• tiredness and weakness
• loss of appetite
• weight loss
• feeling sick
• very itchy skin
• tenderness or pain in your tummy
• tiny red lines (blood capillaries) on the skin
• yellowing of the skin and whites of the eyes (jaundice)

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.

Liver failure

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 however this is becoming rarer due to more people taking advantage of the new DAA treatments. 

Symptoms of liver failure include:

• hair loss
• build-up of fluid in the legs, ankles and feet (oedema)
• build-up of fluid in your tummy (ascites)
• dark urine
• black, tarry stools or very pale stools
• frequent nosebleeds and bleeding gums
• a tendency to bruise easily
• vomiting blood

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.

Liver cancer

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:

• loss of appetite
• unexplained weight loss
• tiredness
• feeling and being sick pain or swelling in your tummy
• jaundice

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.

Could anything I do make hepatitis C worse?

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.

Read some tips on cutting down your alcohol intake.

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.

Is there anything else I can do to help myself?

As well as cutting out alcohol, it can help to:

• control your weight with a healthy diet and regular exercise
• stop smoking
• get vaccinated against hepatitis A and hepatitis B

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.

Do I need a special diet?

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.

How can I avoid spreading the infection to others?

You can reduce the risk of passing hepatitis C on to other people by:

• keeping personal items, such as toothbrushes or razors, for your own use
• cleaning and covering any cuts or grazes with a waterproof dressing
• cleaning any blood from surfaces with household bleach
• not sharing needles or syringes with others
• not donating blood

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.

Do I have to tell my boss?

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.

Can I travel abroad?

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.

Can I have a baby if my partner or I have hepatitis C?

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.