Key facts
- Hepatitis C is an inflammation of the liver caused by the hepatitis C virus.
- The virus can cause both acute and chronic hepatitis, ranging in severity from mild illness to serious, lifelong illness, including cirrhosis and liver cancer.
- Hepatitis C virus is a blood-borne virus, and most infections occur through exposure to blood as a result of unsafe injection practices, unsafe health care, unscreened blood transfusions, intravenous drug use, and sexual practices that lead to exposure to blood.
- It is estimated that 50 million people are chronically infected with hepatitis C virus globally, with approximately 1 million new infections occurring each year.
- In 2022, WHO estimates that approximately 242,000 people will die from hepatitis C, with most of these deaths resulting from cirrhosis and hepatocellular carcinoma (i.e. primary liver cancer).
- Direct-acting antivirals can cure more than 95% of people with hepatitis C infection, but access to diagnosis and treatment is low.
- There is currently no effective vaccine against hepatitis C.
Overview
Hepatitis C is a viral infection of the liver that can cause both acute (short-term) and chronic (long-term) disease. The disease can also threaten the life of the infected person.
Hepatitis C is spread through contact with infected blood. This can happen through sharing needles or syringes, or following unsafe medical procedures such as untested blood and blood product transfusions.
Symptoms of inflammation can include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, and yellowing of the skin or eyes (jaundice).
There is no vaccine for hepatitis C, but it can be treated with antiviral medications.
Serious liver damage can be prevented and the long-term health of those affected can be improved thanks to early detection and treatment of the disease.
Acute infections are usually asymptomatic and most do not lead to life-threatening illness. About 30% (15-45%) of infected people spontaneously clear the virus within 6 months after infection without receiving any treatment.
As for the remaining 70% (55-85%) of infected people, infection with hepatitis C virus becomes chronic, and their risk of developing cirrhosis ranges between 15% and 30% within 20 years.
Geographical distribution
Hepatitis C is prevalent in all WHO regions. The heaviest burden of hepatitis C is in the Eastern Mediterranean Region, where the number of people with chronic infection is 12 million. Its chronic infection is also widespread in Southeast Asia (9 million people), the European region (9 million people), the Western Pacific region (7 million people), the African region (8 million people), and the Americas region (5 million people).
Infection
Hepatitis C virus is a blood-borne virus, and its infection is most often transmitted in the following ways:
- Reuse of medical equipment, especially syringes and needles, in healthcare facilities or insufficient sterilization;
- Transfusion of blood and blood products without examination;
- injection drug use through sharing injection equipment;
Hepatitis C virus may also be transmitted from an infected mother to her fetus, as well as through sexual activity that leads to exposure to blood (for example, between polygamists and men who have sex with other men), but these methods of transmission are less common.
Hepatitis C is not transmitted through breast milk, food, or water, or through casual contact such as hugging, kissing, or sharing food or drinks with an infected person.
Symptoms
Most people with the infection do not show symptoms of the disease in the first weeks after they become infected. It may take between two weeks and six months for symptoms to appear.
When symptoms appear, they may include:
- fever
- Feeling very tired
- Anorexia
- Nausea and vomiting
- Abdominal pain
- Dark urine
- Pale stool
- Arthritis
- Jaundice (yellowing of the skin or eyes).
Examination and diagnosis
Few people are diagnosed when their infection is recent because recent infection with hepatitis C virus usually does not have symptoms. Among people who become chronically infected with hepatitis C virus, the infection also often goes undiagnosed because it remains asymptomatic for decades after infection before secondary symptoms resulting from serious liver damage develop.
Hepatitis C infection is diagnosed in two stages:
1- The test is determined to detect antibodies to the hepatitis C virus using a serological test for people who have been infected with the virus.
2- If the test results confirm the presence of antibodies to the hepatitis C virus, it is necessary to perform a nucleic acid test to detect the presence of hepatitis C virus RNA in order to confirm chronic infection and the need for treatment. This test is important because about 30% of people infected with the virus spontaneously get rid of the infection thanks to a strong immune response without the need for treatment. Although they have cleared the infection, their hepatitis C antibody test results remain positive. DNA testing to detect the presence of RNA can be performed in the laboratory or using a simple point-of-care machine within the clinic.
3- Innovative new tests are being developed as diagnostic methods, such as the hepatitis C core antigen test, and these tests will enable the diagnosis of active hepatitis C infection at a single stage in the future.
After a person is diagnosed with chronic hepatitis C virus infection, the degree of liver damage (cirrhosis and cirrhosis) should be assessed. Liver damage can be assessed by taking a liver biopsy or by performing a variety of non-invasive tests. Evaluation of the degree of liver damage is used to guide treatment decisions and management of the disease.
Early diagnosis can prevent the emergence of health problems that may result from infection and prevent transmission of the virus. The organization recommends testing people who may be at greater risk of infection.
In settings with high seroprevalence of hepatitis C virus antibodies in the general population (high seroprevalence is defined as ≥2% or ≥5%), WHO recommends screening blood donors and conducting focused or targeted testing of specific groups at high risk of contracting the disease. They include migrants from endemic regions, health-care workers, people who inject drugs, people in prisons and other confined settings, men who have sex with other men, sex workers and people infected with HIV.
The organization also recommends that hepatitis C detection tests be made available to all adults and suggests that they be linked to prevention, care and treatment services.
Serological evidence indicates past or current hepatitis C virus infection in approximately 2.3 million of the estimated 39 million people infected with HIV in the world. Chronic liver disease represents a major cause of morbidity and mortality among people living with HIV worldwide.
treatment
Effective treatments are available for hepatitis C. The goal of treatment is to cure the disease and prevent long-term liver damage.
Antiviral medications, including sofosbuvir and daclatasvir, are used to treat hepatitis C. Some people's immune systems may fight the infection on their own and new infections do not always require treatment. Treatment is always necessary in the case of chronic hepatitis C.
People with hepatitis C can also benefit from lifestyle changes such as avoiding alcohol and maintaining a healthy weight. Many people can recover from hepatitis C infection and become healthy with appropriate treatment.
WHO recommends that all genotypes of direct-acting antiviral therapy be provided to all adults, adolescents and children up to 3 years of age with chronic hepatitis C virus infection. Short-term curative courses of oral direct-acting antivirals have few, if any, side effects. Treatment with these antibiotics can cure most people infected with hepatitis C virus, and the duration of treatment is short (usually between 12 and 24 weeks), depending on whether the patient has cirrhosis or not. In 2022, the organization included new recommendations for treating adolescents and children using the same treatments targeting all genotypes used to treat adults.
Direct-acting antivirals that target all genotypes remain expensive in many high- and upper-middle-income countries. However, prices have declined significantly in many countries (mainly low- and lower-middle-income countries) due to the introduction of generic formulations of these medicines. Sofosbuvir and daclatasvir are among the most common and least expensive direct-acting antiviral treatments that target all genotypes. A course of curative treatment is available in many low- and middle-income countries for less than $50.
Access to anti-hepatitis C virus treatment is improving but remains limited. In 2022, an estimated 36% of the 50 million people infected with hepatitis C virus worldwide were aware of their diagnosis. Of all those diagnosed with chronic HIV infection, approximately 20% (12.5 million people) were receiving direct-acting antiretroviral therapy in late 2022.
The provision of services
Until recently, the delivery of hepatitis C testing and treatment services in many countries relied on specialist-led models of care (usually hepatologists or gastroenterologists) in hospitals to deliver complex treatments. The introduction of curative, short-term oral courses of direct-acting antivirals that target all genotypes, and which carry few, if any, side effects, means that a minimum level of experience and surveillance is now necessary. WHO recommends that trained lay doctors and nurses can provide testing, care and treatment for people with chronic hepatitis C virus infection, using simplified service delivery procedures that include decentralization, integration and redistribution of tasks. This can be done in primary care settings, harm reduction settings and prisons and is more accessible and convenient for patients.
Testing, care and treatment services can now be provided safely in primary care facilities, harm reduction services and in prisons, which is more accessible and convenient for patients.
protection
There is no effective vaccine against hepatitis C, and the best way to prevent the disease is to avoid exposure to the virus.
Extra caution should be exercised in health care settings and among people at high risk of hepatitis C virus infection.
People at greatest risk of infection include people who inject drugs, men who have sex with other men, and those infected with HIV.
Among the ways to prevent hepatitis C are the following:
- Safe and appropriate injection practices in health care
- Safe handling and disposal of needles and medical waste
- Providing harm reduction services to people who inject drugs, such as needle exchange programs, substance abuse counseling, and the use of opioid agonist therapy.
- Testing donated blood to detect hepatitis C and other viruses
- Training health workers
- Safe sexual practices using barrier methods such as condoms.