1. What is hepatitis C?

“Hepatitis” means “inflammation of the liver.” There are lots of things that can cause hepatitis, or liver inflammation, including certain medications, excessive amounts of alcohol, and other diseases as well as viruses. Hepatitis can be both short-lived (called “acute”) or ongoing (called “chronic”). 

Hepatitis C virus (HCV) is transmitted from blood-to-blood contact and it can lead to long-term liver damage. If chronically infected, HCV infects the cells of the liver, where it reproduces. Over time, this can lead to scarring and as more and more scarring occurs, it can lead to cirrhosis (where the scars build up and cause liver malfunction) and serious liver problems. Fortunately, HCV can be cured, preventing further liver damage and reducing the risk of developing liver cancer and other problems.

2. How is hepatitis C transmitted?

Hepatitis C is mainly transmitted from blood: When HCV-infected blood gets into you. The main way it is transmitted today is through the sharing of injection equipment: syringes, cookers, cotton, and water. If HCV infected blood gets in or on any of these injection items (“works”), they can transmit HCV to the next person who uses them. 

Hepatitis C is not commonly transmitted through sex. In people living with HIV, especially men who have sex with men (MSM), the risk is higher and sexual transmission of HCV does happen in this group. HCV has been found in the semen and rectal fluids of HIV-positive MSM. Certain sexual practices that can lead to bleeding, including but not limited to fisting and rough sex toy play, can also transmit the virus during sex.

3. Who should be tested for hepatitis C?

Everyone! HCV testing is now recommended for everyone over the age of 18 without the need to ask about potential risk factors. If one has on-going risk for HCV, such as people who inject drugs or people living with HIV, then they should test for HCV more routinely: At least once per year. Test for it routinely so that on the off chance that you get infected, you can get treated and cured as soon as possible. 

4. How do I test for hepatitis C?

Hepatitis C testing is a two-step process: first, you take an HCV antibody test; and second, you confirm the result with a viral load (HCV RNA) test. 

The HCV antibody test will come up either negative or positive. There’s a window period before antibodies appear, similar to HIV. It may take up to 6 months to develop HCV antibodies after your most recent exposure. Additionally, about 1 in 4 persons will clear hepatitis C on their own within six months of infection, but they’ll still always show “positive” on an antibody test. Therefore, you’ll need to get a viral load test too. If you clear HCV, these antibodies cannot protect you from another hepatitis C infection. So, it’s important to protect yourself from re-infection.

A viral load test confirms a positive antibody test. If it comes back positive, then you are chronically infected, meaning that you will have it until you get cured. If you test positive for the HCV virus, talk to your medical provider about treatment options.

5. Can hepatitis C be cured?

Yes, and it is pretty easy to cure these days! The old days of HCV treatment where you had to take pills every day and do an injection once a week for a year and maybe get lucky and get cured are long behind us. Today, HCV direct-acting antivirals, or DAAs, are all oral (pills only), and taken once per day for as little as 8-12 weeks (rarely longer). They are usually very well tolerated with few side effects, all of which are usually very mild. Once cured, your risk of ongoing HCV-related liver disease will stop and you’ll likely reap a host of additional health benefits.

The term we use for hepatitis C cure is “sustained virologic response” or SVR. Sometimes, though very rarely, the virus can bounce back after you’ve finished treatment. When you’re done with treatment, you will wait 12 weeks for your final HCV viral load. If the viral load is undetectable, you have been cured and you don’t have to worry about the virus coming back unless you get exposed and re-infected with the virus again.

6. What HCV medications should I use?

You’ll work with your medical provider to pick the right HCV treatment for you, but there aren’t too many options to pick so it will be pretty easy to choose one. Your treatment decision will also be based on things like treatment experience, drug to drug interactions with other medications you may be taking and other medical conditions you might have. Check out the medications we discuss in this guide to give you a better idea of which one might be best for you.

7. Can I get hepatitis C again?

You can get hepatitis C again: It’s called HCV reinfection. With hepatitis A and hepatitis B, if you get it once and clear it, you can’t get it again. You’ll be naturally immune to reinfection. This is not the case with HCV. Whether you are one of those 20-25% of people who clear the virus naturally (see above) or you clear the virus because you got cured, you can get HCV again. Taking precautions to prevent reinfection, such not sharing any injection equipment, will help you stay HCV negative.

If you’ve had HCV and cleared it or were cured, you will always test positive for the HCV antibodies. In order to know if you’ve gotten it again, you will need to do an HCV viral load test.

8. Is there a vaccine for hepatitis C?

There is no vaccine for HCV. It’s a point of great disappointment for those of us in the HCV world, as a vaccine would play an essential role in preventing new infections and helping us achieve hepatitis elimination. That said, HCV has proven tricky for vaccine development for a number of reasons, including limited options for animal models in early research and the fact that it has a lot of genetic diversity which makes finding a vaccine candidate that protects against all types of HCV tough. There have been attempts in the past to come with a vaccine, and there are a few clinical trials currently underway, but we are a long way from having an effective HCV vaccine 

There is a vaccine for hepatitis A (HAV) and hepatitis B (HBV). If you have HCV you should get vaccinated against HAV and HBV. Talk to your medical provider about the vaccines if you have any questions and want to see if you need to get them.

9. Is there a PrEP or PEP for hepatitis C?

There is PrEP and PEP for HIV, where HIV uninfected persons can take medications before (pre-exposure prophylaxis or “PrEP”) or after (post-exposure prophylaxis or “PEP”) to prevent infection. There is even a PEP for hepatitis B. Unfortunately, there is no PrEP or PEP for HCV. If you are HCV uninfected and concerned about a potential risk of HCV exposure, you should get tested and see if you’ve been infected. Talk with your medical provider about the timing and need for follow-up testing to see if you have it. If you test negative 3 to 6 months after the exposure, you didn’t get it. If you test positive for the virus, you will be treated and cured.

10. How can I be engaged in my medical care and address my concerns?

Playing an active role in your health care is important: Your provider will be an expert in HCV medicine, but you are an expert in your life. Clear and honest lines of communication between you and your physician. 

Here are a few tips to help you make the most out of your medical appointments:

  • Be your best advocate: Study about HCV to understand the disease. Use this Guide to study the medications. Call the Help-4-Hep (1-877-435-7443) phoneline and talk with a peer counselor. You don’t need to be an expert, but having some background on HCV and its treatment will help you be a more informed patient.
  • Write down a list of questions or concerns you have before your appointment and bring them with you so you can ask them at your visit.
  • Take notes about what your medical provider says during your visit.
  • Keep a health journal: Write down any symptoms you may have. Keep a list of all of your medications. Track your adherence (pill taking) of your HCV treatment.
  • Access other local health resources: Many organizations have HCV support and educational groups and case managers and health educators who can help you. Nurses and pharmacists are excellent sources of medical information.

Adapted from Rui Marinho, 2014