What is Hepatitis C?
Hepatitis C is an inflammatory liver disease caused by the Hepatitis C Virus (HCV). The virus primarily infects liver cells and can lead to serious liver damage over time. In most cases, the infection progresses slowly, often causing significant liver damage before any symptoms appear. Chronic infection may result in liver fibrosis, cirrhosis, liver failure, and even liver cancer (hepatocellular carcinoma).
Chronic infection may result in:
Liver fibrosis
Cirrhosis
Liver failure
Liver cancer
Hepatocellular carcinoma
The "Silent Killer"
Hepatitis C is often referred to as the "silent killer" because many infected individuals experience no noticeable symptoms for years.
Approximately 30% of people naturally clear the virus within the first few months after infection. This stage is known as acute hepatitis C infection.
However, if the virus remains in the bloodstream for more than six months, the infection is classified as chronic hepatitis C. Around 70% of infected individuals develop chronic infection.
Symptoms may take 15–20 years to appear.
Approximately 15%–30% of people with chronic hepatitis C eventually develop liver cirrhosis.
Globally, hepatitis C accounts for nearly 27% of liver cirrhosis cases.
Hepatitis C accounts for 25% of liver cancer cases.
It is also one of the leading reasons for liver transplantation.
Once the virus enters the body, it rapidly multiplies until the immune system produces antibodies. Although the immune response may limit the infection, approximately 75% of infected individuals continue to carry the virus for life unless treated.
How Many People Are Affected?
According to the WHO Global Hepatitis Report 2026:
Approximately 47 million people were living with chronic hepatitis C virus (HCV) infection in 2024.
Around 900,000 new HCV infections occurred globally in 2024.
An estimated 240,000 people died from hepatitis C-related cirrhosis and liver cancer in 2024.
Although hepatitis C is curable with highly effective direct-acting antiviral (DAA) medicines, global progress remains off track, and only 20% of people eligible for treatment since 2015 have received it.
Situation in Bangladesh
According to the Directorate General of Health Services (DGHS) Health Bulletin 2024, the estimated prevalence of hepatitis C virus (HCV) infection in Bangladesh is 0.66%, while hepatitis B virus (HBV) prevalence is approximately 4%.
Although the prevalence of hepatitis C is relatively low, thousands of people are living with chronic infection, many of whom remain undiagnosed until they develop advanced liver disease such as cirrhosis or liver cancer.
Hepatitis C virus (HCV) infection in Bangladesh
Hepatitis B virus (HBV) in Bangladesh
Hepatitis C is more infectious than HIV through blood exposure, and there is currently no vaccine to prevent hepatitis C infection. Prevention relies entirely on avoiding exposure to infected blood.
Symptoms of Hepatitis C
Most people have no symptoms until the infection is detected through a blood test.
How Is Hepatitis C Transmitted?
Hepatitis C spreads primarily through contact with infected blood. Transmission may occur through:
- Transfusion of unscreened blood or blood products
- Sharing needles or syringes, particularly among people who inject drugs
- Ear or nose piercing and tattooing with contaminated equipment
- Medical or dental procedures performed with improperly sterilized instruments
- Sharing personal items contaminated with blood, such as:
- Razors
- Blades
- Toothbrushes
- Unprotected sexual contact (less common but possible)
- Mother-to-child transmission during childbirth (approximately 5% risk)
Can Hepatitis C Spread Through Casual Contact?
No. Hepatitis C does not spread through casual contact.
Hepatitis C does NOT spread through:
- Handshakes
- Hugging
- Sharing meals
- Sharing glasses, plates, cups, or utensils
- Sharing clothing
Blood-to-blood contact only
The virus spreads only through blood-to-blood contact. Items contaminated with blood, such as razors, toothbrushes, needles, and blades, can transmit the infection.
- Razors
- Toothbrushes
- Needles
- Blades
Who Is at Risk?
People at increased risk include:
People who inject drugs
Household members and sexual partners of infected individuals
Babies born to mothers with hepatitis C
Healthcare workers frequently exposed to blood, including:
Prevention
There is no vaccine available to prevent hepatitis C.
You can reduce your risk by:
- Avoiding contact with infected blood and body fluids
- Receiving only screened blood and blood products
- Never sharing needles or syringes
- Ensuring sterile equipment is used for medical procedures, dental treatment, tattooing, and body piercing
- Avoiding shared razors, blades, toothbrushes, and other personal items that may be contaminated with blood
- Practicing safer sex, especially if blood exposure is possible
Laboratory Tests for Hepatitis C
Blood tests are essential for diagnosing hepatitis C and monitoring treatment. Follow-up testing is usually performed six months after infection to determine whether the virus has cleared or progressed to chronic infection.
Everyone diagnosed with hepatitis C should consult a hepatologist or gastroenterologist for proper evaluation and treatment.
A foreign substance, such as a protein from the hepatitis C virus, that triggers an immune response.
Antibody
Proteins produced by the immune system in response to HCV infection. A positive Anti-HCV test indicates either a current or previous hepatitis C infection. It does not confirm active infection.
Genetic Material of the Virus
The genetic material of the hepatitis C virus. Detection of HCV RNA confirms an active hepatitis C infection.
Quantitative HCV RNA
The amount of hepatitis C virus present in the blood. Viral load does not indicate the severity of liver damage but is important for monitoring treatment response. This is measured using a quantitative HCV RNA test.
Six Major Genotypes (1–6)
Hepatitis C has six major genotypes (1–6). Although they are all hepatitis C viruses, they differ slightly in genetic structure. Genotyping may be required when planning treatment in certain cases.
Treatment
Being diagnosed with hepatitis C can be distressing. Fortunately, hepatitis C is now a curable disease for most people with modern antiviral therapy.
Some individuals may already have liver damage at the time of diagnosis, while others may not. Preventing additional liver injury is essential.
Patients are advised to:
- Avoid alcohol and smoking
- Get tested and vaccinated against Hepatitis A and Hepatitis B, if not already immune
- Maintain a healthy body weight
- Eat a balanced, nutritious diet
- Attend regular medical follow-up
Early diagnosis and treatment significantly reduce the risk of liver cirrhosis and liver cancer.
Antiviral Therapy
Treatment is recommended for people with chronic hepatitis C to eliminate the virus and prevent progressive liver damage.
Patients should consult a hepatologist or gastroenterologist, who will assess:
- Whether the virus is actively replicating
- The degree of liver damage
- The most appropriate treatment regimen
Historically, treatment consisted of:
- Pegylated Interferon injections
- Ribavirin tablets
These treatments were expensive, had significant side effects, and lower cure rates.
Today, Direct-Acting Antiviral (DAA) medications have revolutionized hepatitis C treatment, achieving cure rates of more than 95%.
- This combination is effective against all major HCV genotypes (pan-genotypic).
- Treatment is generally given for 12–24 weeks, depending on the presence or absence of liver cirrhosis.
- DAAs are highly effective, well tolerated, and have far fewer side effects than older therapies.
Hepatitis C and Pregnancy
Pregnant women with hepatitis C often worry about transmitting the virus to their babies.
The risk of mother-to-child transmission is approximately 5%–10%, which is relatively low.
However, certain hepatitis C medications—particularly Ribavirin—can cause serious birth defects. Women and men taking Ribavirin should use effective contraception and avoid pregnancy during treatment and for the recommended period after treatment, as advised by their physician.
Key Message
- Hepatitis C is often a silent disease with few or no symptoms.
- There is no vaccine against hepatitis C.
- Early diagnosis through blood testing is essential.
- Modern Direct-Acting Antiviral (DAA) medicines can cure more than 95% of patients.
- Preventing exposure to infected blood remains the most effective way to avoid hepatitis C infection.