Hepatitis C: Transmission, Risk Factors, Symptoms, and the Path to Cure

How Hepatitis C Spreads

Hepatitis C virus (HCV) is transmitted through blood-to-blood contact. Primary routes include:

• Sharing needles, syringes, or drug paraphernalia (highest risk)
• Unsafe healthcare practices (needlestick injuries, unsterile equipment)
• Blood transfusions or organ transplants before 1992 (now rare due to universal screening)
• Mother-to-child during birth (~5–6% risk)
• Sexual transmission: low overall, higher with HIV co-infection, rough sex, or multiple partners
• Sharing personal items contaminated with blood (razors, toothbrushes)—rare but possible

Who Should Get Tested

The CDC recommends one-time HCV screening for all adults 18+ and all pregnant women. Additional risk-based testing for:

• Current or former injection drug users
• HIV-positive individuals
• Recipients of clotting factor concentrates before 1987
• Long-term hemodialysis patients
• Healthcare workers after needlestick exposure
• Children born to HCV-positive mothers

Symptoms: Often Silent

Most acute infections are asymptomatic. Chronic HCV may cause:

• Fatigue, malaise
• Right upper quadrant discomfort
• Nausea, poor appetite
• Joint pain
• Jaundice (a late sign)
• Signs of cirrhosis: ascites, variceal bleeding, encephalopathy

Treatment: Curable in Over 95%

Direct-acting antivirals (DAAs)—8–12 week oral regimens like glecaprevir/pibrentasvir or sofosbuvir/velpatasvir—achieve sustained virologic response (SVR) in >95% of patients with minimal side effects. Treatment is indicated for nearly all chronic HCV patients regardless of fibrosis stage.

Prevention

• No vaccine exists yet.
• Harm reduction: syringe services programs, opioid agonist therapy.
• Safe injection practices in healthcare settings.
• Condoms for sexual risk reduction.
• Screening and treating pregnant women to prevent vertical transmission.

With modern therapy, hepatitis C elimination is achievable. Get tested, get cured.