Chronic Hepatitis C

Key facts

• Chronic hepatitis C is a persistent liver infection caused by the hepatitis C virus (HCV), lasting more than six months and capable of damaging the liver quietly for years.
• Most people have few or no symptoms for decades, so the infection is often found incidentally on a routine blood test; left untreated, it can progress to fibrosis, cirrhosis, and in some cases liver cancer.
• Treatment is a short oral course of direct-acting antivirals (DAAs) such as sofosbuvir, ledipasvir, velpatasvir, or daclatasvir, with cure rates above 95%.
• See a doctor for a positive HCV test or unexplained liver enzyme abnormalities; the right drug combination depends on the viral genotype and how much liver damage has already occurred.

How HCV damages the liver over time

The virus replicates inside liver cells and triggers ongoing inflammation. Because symptoms are often absent for decades, chronic hepatitis C is commonly discovered by chance during unrelated blood work. Repeated inflammation gradually causes fibrosis (scarring), and over years this can progress to cirrhosis and, in some cases, hepatocellular carcinoma. A blood test confirms active infection, and a liver stiffness scan or biopsy shows how much fibrosis has already built up.

Direct-acting antivirals: the modern treatment

Current treatment combines direct-acting antivirals taken by mouth for 8 to 12 weeks, curing more than 95% of people treated. Sofosbuvir is a backbone ingredient in many regimens, often paired with ledipasvir, velpatasvir, or daclatasvir. Ribavirin is added for certain harder-to-treat genotypes, and tenofovir disoproxil may be used when HCV occurs alongside hepatitis B or HIV. These regimens have largely replaced older interferon-based treatment, and the right combination depends on HCV genotype and existing liver damage.

Life alongside treatment

Alcohol speeds up liver fibrosis and should be avoided during treatment and ideally well before it. Some commonly used medicines and herbal supplements interact with DAAs, so it is worth reviewing everything taken regularly before starting a course. After a confirmed cure, meaning an undetectable viral load 12 weeks after finishing treatment, liver surveillance may still be recommended for anyone who had advanced fibrosis, since cirrhosis carries a residual cancer risk even once the virus is gone.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.