Hepatitis C virus (HCV) infection affects tens of millions of people worldwide, according to WHO, and causes cirrhosis and liver cancer. Unlike hepatitis B, there is no vaccine, but there is something remarkable: a cure. Direct-acting antiviral (DAA) tablets taken for 8–12 weeks cure more than 95% of people. The biggest barrier is that most people with hepatitis C don’t know they have it. Nurses can change that.
How hepatitis C spreads
- Blood-to-blood contact: sharing needles or drug equipment, unsafe injections and medical procedures, unscreened blood transfusions.
- Needlestick injuries in health workers (less common than with hepatitis B).
- Tattoos, scarification, and traditional procedures with unsterile instruments.
- Less commonly: sexual transmission (higher risk with HIV, or among men who have sex with men), and mother to baby.
- Not spread by hugging, sharing food or water, or breastfeeding (unless nipples are cracked and bleeding).
Why it’s silent
Most people have no symptoms for years or decades while the virus slowly damages the liver. Some clear the virus naturally; most develop chronic infection.
Who should be tested?
WHO recommends testing groups at higher risk, and in some countries testing all adults:
- People who inject or have injected drugs.
- People in prisons.
- People who received blood transfusions or medical procedures before reliable screening, or in settings with poor infection control.
- People living with HIV.
- People with abnormal liver tests or liver disease.
- Health workers after exposure.
- Children of mothers with hepatitis C.
Testing
- Antibody test (rapid or lab): shows past or current infection.
- Confirmatory test for active infection: HCV RNA or core antigen.
WHO now supports simplified approaches, including same-day testing and treatment, and point-of-care viral load tests.
Treatment
- Pan-genotypic DAAs, such as sofosbuvir/daclatasvir or sofosbuvir/velpatasvir, for 12 weeks (or glecaprevir/pibrentasvir for 8 weeks), work across virus genotypes.
- Generic versions have made treatment much more affordable in many low- and middle-income countries.
- Check for drug interactions (including with some HIV medicines and herbal products).
- Assess liver fibrosis (e.g. APRI score or elastography) to identify people with cirrhosis who need ongoing liver cancer screening.
- Cure is confirmed by an undetectable viral load 12 weeks after finishing treatment (“sustained virological response”).
Nurse-led care
WHO recommends task-sharing: trained nurses can test, initiate and monitor DAA treatment, especially in primary care, harm reduction services and prisons. Nurses also support adherence, which is usually straightforward with once-daily tablets.
Reinfection is possible
Cure doesn’t give immunity. Harm reduction services (clean needles and syringes, opioid agonist therapy), safe injection practices in healthcare, and blood screening prevent new infections.
Related: Hepatitis B · Liver cirrhosis care · Needlestick injury
Based on WHO hepatitis C fact sheet and WHO guidelines for the care and treatment of persons diagnosed with chronic hepatitis C. Educational content: follow national guidelines.