Hepatitis C

What you need to know about Hepatitis C

Hepatitis C is a viral infection affecting the liver, caused by the Hepatitis C virus (HCV). The infection causes liver inflammation and, without treatment, can progress to serious complications over time. While acute Hepatitis C can occur in the initial months following infection, most people develop chronic Hepatitis C, which persists beyond six months and requires medical management.

The virus specifically targets liver cells, and chronic infection can lead to progressive liver damage. Left untreated, some patients may develop cirrhosis (severe liver scarring), liver failure, or hepatocellular carcinoma (liver cancer). However, modern antiviral therapies now offer cure rates exceeding 95% across all patient groups, transforming Hepatitis C from a chronic disease into a curable condition.

How common is Hepatitis C in Australia?

Hepatitis C remains the most prevalent blood-borne virus in Australia. While historical estimates suggested around 230,000 Australians were living with chronic Hepatitis C, the widespread availability of curative treatments since 2016 has significantly reduced this burden. Many Australians may have been infected in the past without knowing, as the infection often produces no symptoms for years or even decades.

The availability of highly effective treatments through the Pharmaceutical Benefits Scheme (PBS) has created an opportunity to substantially reduce Hepatitis C prevalence across the Australian community. Early diagnosis and treatment remain key to preventing long-term liver complications.

Understanding how Hepatitis C develops

When Hepatitis C virus enters the body, it travels through the bloodstream to the liver, where it reproduces within liver cells. The body’s immune response to the infection causes liver inflammation, which over time can lead to scarring (fibrosis).

In approximately 25% of cases, the body’s immune system successfully clears the virus within the first six months, resulting in spontaneous resolution of acute Hepatitis C. However, in the remaining 75% of cases, the infection becomes chronic and persists without treatment. Chronic Hepatitis C develops slowly, often taking 20 to 30 years before significant liver damage occurs, though progression rates vary between individuals.

Recognising symptoms and diagnosis

Acute phase symptoms

Most people with acute Hepatitis C experience no symptoms at all. When symptoms do occur during the initial infection phase, they may include fatigue, nausea, poor appetite, abdominal discomfort, dark urine, pale stools, or jaundice (yellowing of the skin and eyes). These symptoms typically appear two to twelve weeks after exposure to the virus.

Chronic hepatitis C symptoms

Chronic Hepatitis C often remains silent for many years, with most infected individuals experiencing no symptoms until significant liver damage has occurred. When symptoms do develop, they may include persistent fatigue, digestive disturbances, joint pain, or symptoms related to advanced liver disease such as fluid accumulation, easy bruising, or confusion.

This absence of early warning signs underscores the importance of testing for individuals who may have been exposed to the virus, rather than waiting for symptoms to appear.

Diagnostic testing

Hepatitis C is diagnosed through blood tests. Initial screening uses an antibody test to detect whether your immune system has ever responded to Hepatitis C virus. A positive antibody test indicates past or current infection, but cannot distinguish between the two. If antibodies are detected, a second test measuring viral RNA (the virus’s genetic material) confirms whether active infection is present.

Your doctor will also arrange testing to identify your viral genotype and assess the degree of liver damage, typically through blood tests measuring liver function and fibrosis markers. In some cases, imaging studies or liver biopsy may be recommended to evaluate liver health.

How is Hepatitis C transmitted?

Hepatitis C spreads through direct contact with infected blood. The virus cannot be transmitted through casual contact, sharing food or drinks, coughing, sneezing, hugging, or kissing. Understanding transmission pathways helps prevent spread and may assist in identifying when infection occurred.

Common transmission routes

Transmission most frequently occurs through sharing needles or other injecting equipment when using drugs. Even sharing other drug-using equipment such as spoons, filters, or tourniquets can transmit the virus if contaminated with blood.

Other transmission pathways include needlestick injuries in healthcare settings, sharing personal items that may have blood on them (such as razors, toothbrushes, or nail clippers), tattooing or body piercing with inadequately sterilised equipment, and certain medical or dental procedures in countries with less stringent infection control standards.

Mother-to-child transmission can occur during pregnancy or childbirth, though this accounts for a small proportion of cases. Sexual transmission of Hepatitis C is uncommon but possible, particularly with practices that may result in blood exposure.

Blood transfusions and blood products received in Australia before widespread screening was introduced (pre-1990) also represent a historical transmission route, though current blood supply screening has eliminated this risk.

Who should consider testing?

Testing is recommended for anyone who has ever injected drugs, received a blood transfusion or blood products before February 1990, had tattoos or body piercings where sterilisation practices may have been inadequate, experienced needlestick injury, received medical or dental treatment in countries with less rigorous infection control, been born to a mother with Hepatitis C, or had sexual partners with known Hepatitis C infection.

Even if exposure occurred many years ago, testing remains important as effective treatment is now available regardless of how long you have been infected.

Understanding viral genotypes

The Hepatitis C virus exists in several genotypes, numbered 1 through 6, with some having additional subtypes. In Australia, genotypes 1 and 3 account for the majority of infections. Your doctor will arrange testing to identify which genotype you have, as this information previously guided treatment selection and duration.

With newer direct-acting antiviral therapies, genotype has become less important for treatment decisions, as modern medicines achieve excellent cure rates across all genotypes. However, knowing your genotype still helps your specialist select the most appropriate treatment regimen for your circumstances.

Modern treatment approaches

Recent pharmaceutical advances have revolutionised Hepatitis C management. Direct-acting antiviral (DAA) medicines target specific proteins the virus needs to reproduce, effectively stopping viral replication and allowing the body to clear the infection. These therapies achieve cure rates exceeding 95% across all genotypes and disease stages.

What “cure” means

In Hepatitis C treatment, cure is defined as sustained virological response (SVR), meaning the virus remains undetectable in your blood twelve weeks after completing treatment. Achieving SVR indicates the infection has been permanently cleared. While your blood will always show antibodies (indicating past exposure), the virus itself is gone and you are no longer infectious to others.

Cure prevents progression of liver disease and substantially reduces the risk of liver cancer, though some residual risk may remain in patients who had already developed advanced fibrosis or cirrhosis before treatment.

Treatment duration and regimens

Modern treatment courses typically range from 8 to 12 weeks, with most patients completing therapy within this timeframe. The specific duration depends on your viral genotype, whether you have received previous treatment, liver disease severity, and which medicines your doctor selects.

Treatment regimens have become considerably simpler than earlier interferon-based approaches. Most patients take one to three tablets once daily. Different combinations of direct-acting antivirals are available, and your specialist will recommend the regimen most suitable for your circumstances.

Improved tolerability for medicines

Contemporary Hepatitis C medicines are significantly better tolerated than traditional interferon-based treatments. Most patients experience minimal side effects, though some may notice fatigue, headache, or mild digestive disturbances. Serious side effects are uncommon.

All medicines carry some potential for side effects, and certain Hepatitis C treatments may interact with other medications you take. Your doctor will review your current medicines before prescribing treatment and monitor you throughout therapy. Discuss any concerns about side effects with your doctor or pharmacist.

Accessing treatment through the PBS

The Australian Government has made breakthrough Hepatitis C medicines available through the PBS, meaning eligible patients can access these treatments at standard PBS co-payment rates rather than paying costs that would otherwise exceed $100,000 per treatment course.

Universal treatment access

Treatment is available through the PBS for all patients with chronic Hepatitis C infection, regardless of genotype, disease severity, or lifestyle factors. This universal access represents a significant public health initiative aimed at eliminating Hepatitis C as a health concern in Australia.

Previous restrictions that limited treatment to patients with advanced liver disease have been removed. Early treatment, before significant liver damage occurs, offers the best long-term outcomes and prevents transmission to others.

Prescribing arrangements

General practitioners can prescribe these medicines in consultation with, or following consultation with, a specialist physician experienced in managing Hepatitis C. Specialist gastroenterologists and hepatologists can also prescribe directly. This flexible arrangement ensures patients can access treatment through pathways that work for their circumstances.

Your GP may refer you to a gastroenterology specialist for initial assessment and treatment planning, then continue prescribing for you under the specialist’s guidance. Alternatively, the specialist may manage your treatment directly.

Treatment costs

Patients pay standard PBS co-payment amounts at each dispensing of medicine. For general patients, this is currently $31.60 per prescription, while concession card holders pay $7.70 per prescription (rates as of 2024, adjusted annually). Most treatment regimens require between one and three prescriptions for a complete course.

For some patients, the PBS Safety Net may further reduce costs once a threshold number of PBS prescriptions have been filled within a calendar year. Your pharmacist can provide information about Safety Net arrangements relevant to your circumstances.

Living with Hepatitis C and preventing transmission

Protecting your liver health

If you have chronic Hepatitis C, several measures can help protect your liver while you arrange treatment. Avoid alcohol consumption, as alcohol accelerates liver damage in people with Hepatitis C. Maintain a healthy weight, as obesity can worsen liver disease. Check with your doctor before taking any new medicines, including over-the-counter medications and herbal supplements, as some can affect liver function.

Vaccination against hepatitis A and hepatitis B is recommended for people with Hepatitis C, as co-infection with these viruses can cause more severe liver disease. Your doctor can arrange these vaccinations if you are not already immune.

Preventing transmission to others

While receiving treatment and after achieving cure, simple precautions prevent potential transmission. Never share needles, syringes, or other drug-using equipment. Avoid sharing personal items that might have blood on them, including razors, toothbrushes, nail clippers, or glucose monitoring equipment. Cover any cuts or sores with waterproof dressings. Clean blood spills with household bleach diluted 1:10 with water.

If you are pregnant or planning pregnancy, inform your healthcare providers about your Hepatitis C status so appropriate management can be arranged. Hepatitis C treatment is not recommended during pregnancy, though it can be safely provided after delivery if you are breastfeeding (discuss with your doctor).

Special populations and access

People who inject drugs

People who currently inject drugs can access and benefit from Hepatitis C treatment. Modern therapies are highly effective regardless of ongoing drug use, and treating people while they are engaged with healthcare services prevents transmission and improves health outcomes. Your treatment team will provide support without judgement.

If you continue injecting after treatment, reinfection is possible if you share equipment. However, reinfection can be treated again with the same highly effective medicines. Your healthcare team can provide advice about accessing clean needles and syringes through needle and syringe programs.

Prisoners and custodial settings

Recognising that people in custodial settings represent a priority population for Hepatitis C treatment, the Government has agreed to fund these medicines for prisoners through the PBS. State and territory health and justice departments have established processes to ensure prisoners can be assessed, prescribed, and provided with appropriate treatment.

Life after Hepatitis C cure

Achieving sustained virological response means you are cured of Hepatitis C infection. The virus is permanently eliminated from your body, and you are no longer infectious to others. However, cure does not provide immunity to future infection, so you can be reinfected if exposed to the virus again through blood contact.

After cure, some liver damage that occurred before treatment may persist, particularly if you had advanced fibrosis or cirrhosis. Your specialist will discuss any need for ongoing liver monitoring based on the degree of liver damage present before treatment. For most patients who are treated before significant liver damage occurs, life expectancy and liver function return to normal.

Your blood tests will continue to show Hepatitis C antibodies, indicating past exposure to the virus. This does not mean you still have the infection. If you need to prove you are cured, a test measuring Hepatitis C viral RNA will show no detectable virus.

Taking the next step

If you have been diagnosed with Hepatitis C, believe you may have been exposed to the virus, or fall into any of the groups recommended for testing, speak with your general practitioner. Your doctor can arrange appropriate testing, provide referral to a gastroenterology specialist if needed, and discuss treatment options suitable for your circumstances.

Modern medicines offer the opportunity to cure Hepatitis C and prevent long-term liver complications. Early assessment and treatment, where appropriate, provides the best outcomes. Treatment is straightforward, highly effective, and accessible through the PBS at standard co-payment rates.

Further information and support

Your treating doctor and pharmacist remain your primary sources of information about Hepatitis C management and treatment. The Department of Health maintains comprehensive information about Hepatitis C on their website, and organisations such as Hepatitis Australia provide support and education resources for people affected by Hepatitis C.

Your gastroenterology team at Queensland Gastroenterology is here to support you through assessment, treatment, and ongoing care. We understand Hepatitis C treatment can raise questions and concerns, and we encourage you to raise these at your consultations. Our specialists have extensive experience managing Hepatitis C and are committed to providing you with the highest quality care.

This information has been sourced and adapted from resources developed by Health Direct Australia, Centres for Disease Control, Australia, and The Pharmaceutical Benefits Scheme.

Last reviewed: 06/02/2026