Hepatitis C: introduction

Hepatitis C is an infectious disease characterised by inflammation of the liver. It is caused by the hepatitis C virus (HCV), which is a bloodborne virus first discovered in 1989. In Scotland and the UK, it is transmitted primarily through sharing of contaminated needles either for drug use or in a healthcare setting, and through blood transfusions and blood products in prior to 1996 (World Health Organisation [WHO], 2024; UK Parliament, 2024). More information on the modes of transmission and risk groups can be found in the section on Risk Factors.

Although 15-45% of those infected with HCV clear the virus without treatment in less than six months, in the majority of cases the disease becomes chronic. Untreated chronic HCV infection increases risk of cirrhosis (scarring of the liver), liver cancer and liver failure, with onset typically occurring 15-20 years after infection (WHO, 2024). Early diagnosis is therefore key to reducing morbidity and mortality. As hepatitis C is often symptomless until liver damage is present, regular screening of risk groups is undertaken to facilitate early diagnosis (National Institute for Health and Care Excellence [NICE], 2022). There is currently no vaccine to prevent HCV infection.

Diagnosis of HCV infection requires two blood tests. First, an antibody test is used to identify whether an individual has ever been infected. Following a positive result an RNA test is used to confirm whether infection is currently active. After diagnosis, further tests to identify the virus subtype and assess the viral load (quantity of virus in the blood) and liver function may be performed to influence treatment (NICE, 2022).

HCV infection can be cured in more than 90% of cases using an 8-12 week course of direct-action antiviral agents (DAAs) such as sofosbuvir (National Health Service [NHS], 2021). Lifestyle changes such as limiting alcohol intake, eating a balanced diet and exercising regularly can help limit liver damage during infection (NHS, 2021). The introduction of DAAs has led to an expansion of treatment pathways from specialist-led hospital clinics to primary care and harm-reduction services (Whiteley et al, 2022).

In 2019, the Scottish Government committed to the elimination of hepatitis C as a public health concern by 2024. Therefore, the wider impact of HCV in Scotland is increasingly limited. However, historical infected blood transfusions have resulted in substantial negative impacts on life expectancy and quality of life for around 3,000 individuals in Scotland (Scottish Government, 2024).