Hepatitis C is a viral infection that primarily targets the liver, causing inflammation and potentially leading to serious complications if left untreated. The hepatitis C virus (HCV) is a blood-borne pathogen that can cause both acute and chronic liver disease. When the virus enters the body, it specifically attacks liver cells, disrupting normal liver function and potentially causing scarring (fibrosis) over time. The liver's ability to process toxins, produce essential proteins, and store nutrients can become compromised as the infection progresses.
Acute hepatitis C occurs within the first six months of infection and often presents with mild or no symptoms, making it difficult to detect early. During this phase, some individuals may naturally clear the virus from their system without treatment. However, approximately 75-85% of people with acute HCV will develop chronic hepatitis C, where the virus persists in the body for years or decades. Chronic infection poses the greatest risk for serious liver complications, including cirrhosis, liver failure, and hepatocellular carcinoma.
Hepatitis C is transmitted through direct contact with infected blood. Common transmission routes include sharing needles or drug preparation equipment, receiving contaminated blood transfusions (particularly before 1992), and through certain medical procedures with inadequate infection control. Additional risk factors include:
Many people with hepatitis C experience no symptoms for years, earning it the designation as a "silent" disease. When symptoms do occur, they may include fatigue, joint pain, abdominal discomfort, and dark urine. As the disease progresses to advanced liver damage, more serious symptoms can develop, including jaundice, fluid retention, confusion, and bleeding complications. The progression from initial infection to cirrhosis typically takes 20-30 years, though this timeline can vary significantly based on factors such as age at infection, alcohol consumption, and co-infection with other viruses.
Early detection of hepatitis C is crucial for preventing serious liver complications and reducing transmission to others. The NHS recommends testing for individuals with risk factors, and routine screening is available through GP surgeries and specialist clinics. Modern diagnostic tests can detect both HCV antibodies and active viral infection through PCR testing. Early diagnosis allows for timely treatment intervention, which can cure the infection in over 95% of cases and prevent progression to advanced liver disease.
Hepatitis C exists in six main genotypes, with genotypes 1 and 3 being most prevalent in the United Kingdom. Genotype 1 accounts for approximately 45% of UK cases, whilst genotype 3 represents about 40% of infections. Genotype 2 is less common, representing roughly 10% of cases. Understanding the specific genotype is important for treatment planning, as different genotypes may respond differently to certain antiviral medications, although modern pan-genotypic treatments have largely simplified this consideration.
The treatment landscape for hepatitis C has been revolutionised by direct-acting antivirals (DAAs), which target specific steps in the HCV life cycle. These oral medications have transformed hepatitis C from a difficult-to-treat condition requiring lengthy interferon-based regimens to a highly curable infection with short treatment courses. Modern DAA therapy typically involves combination tablets taken once daily for 8-12 weeks, achieving cure rates exceeding 95% across all genotypes. The NHS provides access to these treatments through specialist hepatology services and increasingly through primary care settings.
Sofosbuvir is a nucleotide analogue that inhibits the HCV NS5B polymerase, serving as the backbone for several highly effective combination treatments. This medication is typically combined with other DAAs to create potent treatment regimens that prevent viral resistance. Sofosbuvir-based therapies have demonstrated excellent efficacy across different patient populations, including those with cirrhosis and treatment-experienced individuals. The medication is generally well-tolerated, with most patients experiencing minimal side effects during treatment.
Maviret represents a significant advancement in HCV treatment, offering a pan-genotypic approach that is effective against all major hepatitis C genotypes. This fixed-dose combination contains glecaprevir (an NS3/4A protease inhibitor) and pibrentasvir (an NS5A inhibitor), providing comprehensive viral suppression. The standard treatment duration is 8 weeks for most treatment-naïve patients without cirrhosis, extending to 12 weeks for those with compensated cirrhosis or previous treatment experience. Maviret has shown excellent efficacy rates and a favourable safety profile in clinical trials and real-world use.
Epclusa combines sofosbuvir with velpatasvir (an NS5A inhibitor) to provide another highly effective pan-genotypic treatment option. This once-daily tablet regimen typically requires 12 weeks of treatment and has demonstrated cure rates of 95-99% across all HCV genotypes. Epclusa is particularly valuable for patients with genotype 2 and 3 infections, which were historically more challenging to treat. The combination is well-suited for patients with compensated cirrhosis and has shown consistent efficacy in diverse patient populations, making it a cornerstone of modern HCV treatment protocols in the UK.
Modern hepatitis C treatment has revolutionised patient outcomes through highly effective direct-acting antiviral (DAA) combinations. These treatments are tailored to specific HCV genotypes and patient circumstances, ensuring optimal cure rates whilst minimising treatment duration and side effects.
Ledipasvir/Sofosbuvir represents a cornerstone treatment for multiple HCV genotypes available through the NHS. This fixed-dose combination tablet contains 90mg ledipasvir and 400mg sofosbuvir, taken once daily. The treatment demonstrates exceptional efficacy rates exceeding 95% for treatment-naïve patients with genotypes 1, 4, 5, and 6. Patients with genotype 1a or 1b infection, which are the most prevalent genotypes in the UK, respond particularly well to this regimen. The treatment is generally well-tolerated, with common side effects including fatigue and headache.
Vosevi offers a vital treatment option for patients who have previously failed DAA therapy or have challenging clinical presentations. This triple-combination therapy contains 400mg sofosbuvir, 100mg velpatasvir, and 100mg voxilaprevir in a single daily tablet. It demonstrates remarkable efficacy against all HCV genotypes, including resistant variants. Treatment-experienced patients, including those with previous NS5A inhibitor failure, achieve cure rates of approximately 96-98%. This makes Vosevi particularly valuable for salvage therapy in complex cases managed within specialist hepatology services across the UK.
Ribavirin may be added to DAA regimens in specific clinical circumstances to enhance treatment efficacy. Weight-based dosing typically ranges from 1000-1200mg daily, divided into morning and evening doses. Healthcare providers consider ribavirin addition for patients with cirrhosis, prior treatment failure, or certain genotype 3 infections. However, ribavirin can cause haemolytic anaemia and requires careful monitoring of haemoglobin levels throughout treatment. Contraindications include pregnancy and significant cardiovascular disease, necessitating thorough patient assessment before initiation.
Treatment duration varies based on several clinical factors, with standard protocols established through extensive clinical trials:
Healthcare providers evaluate multiple factors when selecting appropriate HCV treatment regimens. HCV genotype testing remains fundamental, as different genotypes respond variably to specific DAA combinations. Liver fibrosis staging through FibroScan or biopsy influences both drug selection and treatment duration, with cirrhotic patients often requiring extended therapy. Prior treatment history, including response to interferon-based regimens or previous DAA failure, significantly impacts therapeutic decisions. Patient factors such as renal function, drug interactions with existing medications, and pregnancy status also guide treatment personalisation. Additionally, HIV or hepatitis B co-infection requires specialist management with modified treatment protocols to ensure optimal outcomes whilst preventing viral resistance development.
The NHS provides comprehensive treatment for hepatitis C through established clinical pathways. All patients with confirmed chronic hepatitis C infection are eligible for direct-acting antiviral (DAA) treatment, regardless of disease stage or lifestyle factors. NHS England has prioritised HCV treatment as part of its commitment to eliminate hepatitis C by 2030, ensuring equitable access across all regions.
Patients can access hepatitis C treatment through multiple pathways. Initial referrals typically begin with your GP, who can arrange hepatitis C testing and refer to specialist services. Many areas also offer direct access through:
Whilst treatment is available to all patients with hepatitis C, certain groups may receive prioritised access to ensure rapid treatment initiation. These include patients with advanced liver disease, those co-infected with HIV or hepatitis B, pregnant women, and individuals in high-risk groups such as people who inject drugs or those in prison settings.
Regular monitoring during treatment ensures optimal outcomes and safety. This typically includes baseline assessments, treatment adherence support, and post-treatment follow-up to confirm sustained virologic response (SVR). Most patients require minimal monitoring due to the excellent safety profile of modern DAA treatments.
Hepatitis C treatment is fully funded by the NHS, with no cost to patients. Prescriptions are available through NHS prescription charges in England, though many patients qualify for free prescriptions. In Scotland, Wales, and Northern Ireland, all prescriptions are free of charge.
Modern direct-acting antiviral treatments are generally well-tolerated with minimal side effects. The most commonly reported side effects include fatigue, headache, nausea, and occasional sleep disturbances. These are typically mild and resolve during or shortly after treatment completion. Serious side effects are rare, making DAA therapy suitable for most patients, including those with other health conditions.
Healthcare providers carefully review all medications before starting hepatitis C treatment to identify potential drug interactions. Some medications may require dose adjustments or temporary discontinuation. Common interactions include certain heart medications, seizure medications, and some herbal supplements. Always inform your healthcare team about all medications, supplements, and over-the-counter products you're taking.
Treatment monitoring is typically straightforward, with most patients requiring only basic blood tests before and after treatment. Regular appointments ensure treatment adherence and provide opportunity to address any concerns. The simplified monitoring requirements make treatment accessible even for patients with complex social circumstances.
Most side effects can be managed with simple measures such as adequate rest, hydration, and over-the-counter pain relief. Contact your healthcare provider if you experience:
Sustained virologic response (SVR) is achieved when hepatitis C virus is undetectable 12 weeks after treatment completion, indicating cure. Post-treatment care includes SVR testing and long-term liver health monitoring. Patients who achieve SVR have excellent long-term outcomes and significantly reduced risk of liver-related complications.
Preventing hepatitis C transmission involves avoiding contact with infected blood. Key prevention measures include never sharing needles, syringes, or drug preparation equipment, using barrier protection during sexual activity, and ensuring safe practices for tattoos and piercings. Healthcare settings maintain strict infection control procedures to prevent transmission.
Supporting liver health through lifestyle modifications enhances treatment outcomes and long-term wellbeing. Recommendations include limiting alcohol consumption, maintaining a healthy diet, regular exercise, and avoiding hepatotoxic substances. These measures are particularly important for patients with existing liver damage or other risk factors.
Post-treatment monitoring confirms treatment success and assesses liver health recovery. This includes SVR testing at 12 weeks post-treatment and ongoing liver function monitoring. Patients with advanced liver disease may require continued specialist care and regular screening for complications.
Vaccination against hepatitis A and hepatitis B is recommended for all patients with hepatitis C to prevent co-infection, which can worsen liver disease progression. These vaccinations are available through your GP or specialist clinic and are particularly important for high-risk individuals. The vaccines are safe and effective, providing long-term protection.
Maintaining liver health after hepatitis C treatment involves ongoing lifestyle measures and regular healthcare monitoring. This includes alcohol moderation, maintaining healthy weight, managing diabetes and other health conditions, and regular check-ups with your healthcare provider. Patients with cirrhosis require continued specialist monitoring even after successful treatment.
Numerous organisations provide support, information, and advocacy for people affected by hepatitis C. Key resources include the British Liver Trust, Hepatitis C Trust, and local patient support groups. These organisations offer educational materials, peer support, and assistance navigating healthcare services, providing valuable support throughout the treatment journey and beyond.
