Symptoms, transmission, and current treatments for hepatitis C
What is hepatitis C?
Hepatitis C is a liver disease caused by the hepatitis C virus. Hepatitis C can cause a mild illness of a few weeks or develop into a serious, lifelong, chronic illness. It is a major cause of cancer and cirrhosis of the liver, and if not treated, it can be fatal.
Hepatitis C is transmitted through exposure to small quantities of blood. People who inject drugs are at particular risk. About 30% of people infected clear the virus within 6 months without treatment. The remaining 70% develop chronic hepatitis C and for these, the risk of liver cirrhosis ranges between 15% and 30% within 20 years. 75% of those reported as living with chronic hepatitis C live in low- and middle-income countries.
What is the impact of hepatitis C?
- 71 million people have hepatitis C
- 75% of people with hepatitis C live in low- and middle-income countries
- About 40% of all people with hepatitis C live in 4 countries: China, Pakistan, India, and Egypt
- 80% are unaware they are infected
- only 7% have had access to treatment
- 2.3 million people have both HIV and hepatitis C
- 15–30% of those chronically infected develop cirrhosis of the liver within 20 years
- >1,000 people die every day
Hepatitis C is found throughout the world. There are six different major strains of hepatitis C, known as genotypes, distributed across different regions, with genotype 1 being most prevalent in high-income countries and genotype 3 most prevalent in low- and middle-income countries. Genotype 3 accounts for 30% of global hepatitis C infection.
What are current treatments for hepatitis C?
Pegylated-interferon with ribavirin (standard treatment for chronic hepatitis C until 2011)
- 40-80% cure rate
- poorly tolerated
- long (48 week) treatment duration
- complex management of the treatment
- administered by injection
- difficult to access in some settings.
Direct acting antivirals (WHO recommended since 2016)
- highly effective (cure rates of >95% in clinical trials)
- safer and better tolerated than existing therapies
- shorter (12- or 24-week) treatment duration
- oral formulation
- simpler monitoring and laboratory requirements
- access is quite limited, mostly because of high cost
What new treatments for hepatitis C are needed?
The World Health Organization’s Global Strategy on Viral Hepatitis aims for 90% of people with hepatitis C virus to be diagnosed, and 80% of those eligible to be treated by 2030. With cure rates of 90% and above, direct-acting antivirals have opened up the possibility of rolling back the disease. Moreover, if people are diagnosed and treated early enough to avoid infecting others, the disease could be eliminated. But as of today, treatment remains largely unaffordable, so national hepatitis C programmes to scale up diagnosis and treatment are stalled.
A simple, affordable treatment that works for all six strains of hepatitis C is needed to enable a comprehensive public health approach that can reverse the epidemic.
What hepatitis C medicines are we working on?
We aim to develop a safe, effective, and easy-to-use direct-acting antiviral regimen, to be used as an affordable combination paving the way for a public health approach to hepatitis C. We also aim to increase access to affordable treatments by supporting policy change and encouraging political will to treat hepatitis C. To do so, we are working on innovative programmes to improve access to hepatitis C diagnosis and treatment in a variety of countries.
Find out about our work developing treatments for hepatitis C
How do you get hepatitis C?
Hepatitis C is a blood-borne virus. The most common ways to get infected are:
- unsafe injection practices
- inadequate sterilization of medical equipment
- blood transfusions of un-screened blood or blood products
Hepatitis C can also be transmitted sexually and be passed from mother to child, but these types of transmission are less common.
What are the symptoms of hepatitis C?
Following infection, there is an incubation period of 2 weeks to 6 months. After this period, approximately 80% of people show no symptoms.
The acutely infected may have these symptoms:
- decreased appetite
- abdominal pain
- dark urine
- grey-coloured faeces
- joint pain
- jaundice (yellowing of the skin and the whites of the eyes)
How is hepatitis C diagnosed?
Hepatitis C infection is diagnosed in two steps:
- A serological test is used to test for hepatitis C antibodies, produced by the body to fight the infection.
- A nucleic acid test is used to test for hepatitis C ribonucleic acid to confirm chronic infection. This test is needed because about 30% of people infected with hepatitis C whose infection clears up by itself will still test positive for hepatitis C antibodies long after they are no longer infected.
Existing diagnostic tests remain too complex and/or too expensive for countries with limited budgets, weak health systems, or both. Simple, more affordable tests are needed.
We are working with FIND and the Ministry of Health in Malaysia to simplify hepatitis C screening and make it more widely available.
Last updated: November 2019
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