Highlights
- Hepatitis C affects around 50 million people globally, with significant socioeconomic and health impacts, underscoring the need for effective interventions.
- Current treatment advancements have improved cure rates, yet the absence of a vaccine remains a major challenge in eradication efforts.
- Universal screening and timely treatment are essential to combat hepatitis C, emphasizing the importance of expanded healthcare access and support.
Summary and Overview
Hepatitis C is a liver disease caused by the hepatitis C virus (HCV), infecting around 50 million people worldwide as of 2025. Often asymptomatic initially, it frequently progresses to chronic liver disease, including cirrhosis and cancer. Despite highly effective direct-acting antivirals (DAAs), no vaccine exists, complicating eradication. The highest disease burden is in low- and middle-income countries, especially the Eastern Mediterranean, South-East Asia, and Western Pacific regions. Injection drug use is the primary transmission mode globally, alongside unsafe medical practices and blood transfusions. Diagnosis relies on universal screening and sensitive assays, while treatment uses pan-genotypic DAAs. Global elimination by 2030 requires expanded prevention, screening, treatment, and addressing socioeconomic barriers.
Virology and Transmission
HCV is a genetically diverse RNA virus with seven major genotypes and many subtypes, influencing treatment response and epidemiology. Genotype 1 is most common worldwide, with others distributed regionally. The virus replicates via a complex life cycle involving host cell membrane structures. Transmission primarily occurs through blood exposure, notably sharing needles among people who inject drugs (PWID). Historically, unscreened blood transfusions and unsafe injections contributed significantly, especially in low-resource settings. Sexual and perinatal transmission are less common but notable in high-risk groups like men who have sex with men (MSM) and people living with HIV. Prevention focuses on harm reduction, safe medical practices, and blood screening.
Risk Factors and Clinical Presentation
Major risk factors include injection drug use, incarceration, unsafe healthcare practices, and high-risk sexual behaviors. Socioeconomic and cultural barriers limit access to care, increasing vulnerability in marginalized populations. Acute infection is often asymptomatic or mild, making early detection difficult. Chronic infection develops in most cases, leading to progressive liver damage, cirrhosis, and hepatocellular carcinoma if untreated. Early diagnosis and treatment are crucial to prevent severe outcomes.
Diagnosis and Treatment
Diagnosis combines antibody and RNA testing, supported by liver function tests and imaging to assess liver damage. The CDC recommends universal screening for adults and pregnant women to improve detection. New point-of-care tests facilitate rapid diagnosis, especially in low-resource settings. Treatment is centered on DAAs, which provide high cure rates with shorter, all-oral regimens effective across genotypes. Careful management addresses drug interactions and resistance, particularly for unusual subtypes. Lifestyle counseling and monitoring for co-infections complement antiviral therapy. Ribavirin and interferon are largely replaced due to inferior efficacy and side effects. WHO emphasizes expanding testing and treatment to meet elimination goals.
Monitoring and Long-Term Management
Noninvasive methods like liver elastography have largely replaced biopsy for monitoring fibrosis. Genotype and resistance testing guide therapy choices. On-treatment monitoring detects liver injury or decompensation, requiring specialist intervention if present. Long-term surveillance continues after viral clearance, especially for patients with cirrhosis, due to ongoing hepatocellular carcinoma risk. Psychosocial support is important for treatment adherence and overall wellbeing.
Prevention and Public Health Challenges
Prevention targets injection drug use through needle exchange programs and safe medical practices, including blood screening. Behavioral interventions focus on high-risk groups such as MSM and people with HIV. Despite advances in treatment, lack of a vaccine remains a major barrier. Socioeconomic disparities hamper equitable access to care, necessitating policy efforts to reduce drug costs and improve healthcare access. Monitoring demographic and epidemiological trends informs targeted interventions. WHO aims to eliminate hepatitis C as a public health threat by 2030 through integrated prevention, diagnosis, and treatment strategies.
Epidemiology and Future Directions
HCV remains a significant global health issue with concentrated burdens in LMICs, notably China, Pakistan, and India. Injection drug use continues to drive new infections, exacerbated by the opioid epidemic in some regions. Structural barriers limit testing and treatment access among vulnerable populations. Meeting WHO elimination targets requires substantially increased diagnostic and therapeutic efforts. Research focuses on viral evolution, resistance, and novel diagnostics, with point-of-care testing playing a key role. Development of a vaccine capable of preventing chronic infection is a critical goal. Advances in molecular tools and understanding of HCV biology support ongoing progress toward global control and eventual eradication.
The content is provided by Blake Sterling, Scopewires
