Hepatitis C is a viral infection that primarily targets the liver, causing inflammation and potentially serious long-term damage. The virus interferes with normal liver function, affecting the organ's ability to process toxins, produce essential proteins, and store nutrients. Without proper treatment, chronic hepatitis C can progress to cirrhosis, liver failure, or hepatocellular carcinoma. The infection is often called a "silent disease" because many people experience no symptoms for years whilst the virus gradually damages liver tissue, making early detection and treatment crucial for preventing irreversible complications.
Australia predominantly sees hepatitis C genotypes 1 and 3, which account for approximately 90% of all infections nationwide. Genotype 1a is the most prevalent, followed by genotype 3a and genotype 1b. These genotypes influence treatment approaches and duration, though modern direct-acting antiviral (DAA) therapies are highly effective against all common Australian strains. Genotype testing is essential for determining the most appropriate treatment regimen, with most patients achieving sustained virological response rates exceeding 95% regardless of their specific genotype.
Hepatitis C spreads primarily through blood-to-blood contact, with several key transmission pathways identified in Australia. The most common risk factors include sharing needles or drug preparation equipment, receiving blood transfusions or organ transplants before 1990, and certain medical procedures in countries with inadequate infection control. Other risks encompass sharing personal items like razors or toothbrushes, unsterile tattooing or body piercing, and occupational needle-stick injuries among healthcare workers. Sexual transmission is possible but less common, though risk increases with multiple partners or concurrent sexually transmitted infections. Vertical transmission from mother to child occurs in approximately 5% of cases.
Hepatitis C infection progresses through distinct stages, often without noticeable symptoms initially. Acute infection may cause fatigue, nausea, abdominal pain, and jaundice, though 70-80% of people experience no symptoms. Chronic infection develops when the virus persists beyond six months, potentially remaining asymptomatic for decades. Common chronic symptoms include persistent fatigue, joint pain, brain fog, and depression. Advanced stages may present with signs of liver dysfunction such as easy bruising, fluid retention, confusion, and yellowing of skin or eyes. The progression varies significantly between individuals, with factors like alcohol consumption, age at infection, and co-infections influencing disease advancement and liver damage severity.
Australia offers comprehensive hepatitis C testing through various healthcare settings, including GP clinics, sexual health centres, and community health services. Initial screening involves an anti-HCV antibody test, which detects previous exposure to the virus. If positive, a HCV RNA test confirms active infection and measures viral load. Additional tests include genotype analysis to guide treatment selection and liver function assessments. Point-of-care rapid testing is available in some locations, providing results within 20 minutes. All testing is covered under Medicare, ensuring accessibility for Australian residents seeking diagnosis and monitoring.
The Australian government recommends hepatitis C testing for adults born between 1945-1970, people who inject drugs, indigenous Australians, and those with identified risk factors. Testing should occur after potential exposure events, during routine healthcare visits for at-risk populations, and as part of sexual health screening. Healthcare providers may recommend testing for patients with unexplained liver abnormalities or chronic fatigue. Regular screening is advisable for ongoing risk behaviours, with annual testing recommended for people who inject drugs.
Test results indicate different infection stages and treatment needs across Australia. A positive antibody test with undetectable RNA suggests cleared infection, whilst detectable RNA confirms active hepatitis C requiring treatment. Viral load measurements, expressed as copies per millilitre, help monitor treatment response and determine cure. Key result categories include:
Sofosbuvir-based combination therapies represent the cornerstone of hepatitis C treatment in Australia. Harvoni combines sofosbuvir with ledipasvir, providing highly effective treatment for genotypes 1, 4, 5, and 6. Epclusa, containing sofosbuvir and velpatasvir, offers pan-genotypic coverage, treating all HCV genotypes effectively. These oral medications have revolutionised hepatitis C treatment with their excellent safety profiles and minimal side effects. Both treatments are available through the Pharmaceutical Benefits Scheme (PBS), making them accessible to eligible patients across Australia. Clinical studies demonstrate exceptional cure rates exceeding 95% for most patient populations when treatment adherence is maintained.
Maviret represents another highly effective pan-genotypic treatment option available in Australia, combining glecaprevir and pibrentasvir in a single tablet formulation. This medication treats all major HCV genotypes with excellent efficacy rates. Maviret offers the advantage of shorter treatment durations for many patients, often requiring only 8-12 weeks of therapy. The medication is particularly beneficial for treatment-naïve patients and those without cirrhosis. Side effects are generally mild, with the most common being fatigue and headache.
Modern DAA treatments in Australia typically require 8-12 weeks of therapy, significantly shorter than previous interferon-based regimens. Treatment duration depends on factors including HCV genotype, previous treatment history, and presence of cirrhosis. Cure rates, measured as sustained virological response (SVR), consistently exceed 95% across all approved DAA medications. Most patients achieve undetectable viral loads within 4-6 weeks of starting treatment, with cure confirmed 12 weeks post-treatment completion.
The PBS provides subsidised access to DAA medications for eligible patients in Australia. Prescriptions must be initiated by gastroenterologists, hepatologists, infectious disease specialists, or approved general practitioners with relevant experience. Key eligibility criteria include confirmed HCV infection, assessment of liver fibrosis, and documentation of treatment readiness. Patients require regular monitoring during treatment, including baseline and follow-up blood tests. The PBS covers treatment for all genotypes and most patient populations, including those with previous treatment failure or co-infections, ensuring equitable access to life-saving hepatitis C therapy.
Australian hepatitis C treatment guidelines, developed by leading hepatology organisations, recommend DAA therapy for all patients with chronic HCV infection, regardless of disease stage. The guidelines emphasise early treatment initiation to prevent disease progression and reduce transmission risk. Treatment protocols prioritise pan-genotypic regimens due to their broad efficacy and simplified prescribing. Regular updates ensure recommendations reflect the latest clinical evidence and drug availability. The guidelines support a patient-centred approach, considering individual circumstances, comorbidities, and treatment preferences when selecting optimal therapy regimens.
While modern pan-genotypic DAA treatments effectively target all HCV genotypes, specific considerations may influence treatment selection. Genotype 3 historically required longer treatment durations, particularly in patients with cirrhosis. Genotypes 1 and 4 respond excellently to most available regimens. Australian guidelines recommend genotype testing primarily for epidemiological purposes, as treatment decisions increasingly rely on pan-genotypic options that eliminate genotype-specific treatment complexity.
Special patient populations require tailored treatment approaches and enhanced monitoring protocols. Key considerations include:
These populations achieve excellent cure rates with appropriate specialist oversight and individualised treatment planning.
Modern direct-acting antiviral (DAA) medications for hepatitis C are generally well-tolerated, but some patients may experience side effects during treatment. The most commonly reported side effects include fatigue, headache, nausea, and mild gastrointestinal symptoms such as diarrhoea or abdominal discomfort. Some patients may also experience difficulty sleeping, dizziness, or changes in appetite. These side effects are typically mild to moderate and often improve as your body adjusts to the medication.
It's important to note that the side effect profile varies depending on the specific DAA regimen prescribed. Your healthcare provider will discuss the potential side effects specific to your treatment plan. Most side effects are temporary and resolve once treatment is completed. However, if you experience severe or persistent symptoms, contact your healthcare provider immediately for guidance.
HCV medications can interact with various other medicines, supplements, and even some foods. These interactions can either reduce the effectiveness of your hepatitis C treatment or increase the risk of side effects. It's crucial to inform your healthcare provider and pharmacist about all medications you're taking, including prescription medicines, over-the-counter drugs, herbal supplements, and vitamins.
Common medications that may interact with HCV treatments include:
Regular monitoring during HCV treatment is essential to ensure the medication is working effectively and to identify any potential complications early. Your healthcare provider will schedule regular blood tests to monitor your liver function, viral load, and overall health throughout the treatment period. These tests typically occur at the start of treatment, during treatment (usually at 4-week intervals), and at the end of treatment.
The monitoring process includes checking your HCV RNA levels to confirm the virus is responding to treatment, liver function tests to ensure your liver is coping well with the medication, and complete blood counts to monitor for any changes in your blood cells. Your healthcare provider may also check for any drug interactions if you're taking other medications concurrently.
Even after successful treatment, it's important to understand how hepatitis C is transmitted to prevent reinfection and protect others. Hepatitis C is primarily spread through blood-to-blood contact, and there is no vaccine available for prevention. The virus can survive outside the body for extended periods, making proper precautions essential.
Key prevention strategies include:
Achieving a sustained virological response (SVR) means you've been cured of hepatitis C, but ongoing medical care remains important. Your healthcare provider will schedule follow-up appointments to monitor your liver health and overall wellbeing. A blood test 12 weeks after completing treatment will confirm SVR, indicating successful cure of the infection.
Long-term follow-up care typically includes annual health check-ups with liver function monitoring, particularly if you had significant liver damage before treatment. Your doctor may recommend ongoing screening for liver cancer if you had advanced liver disease, and regular monitoring for other health conditions that may have been affected by the previous hepatitis C infection.
Maintaining optimal liver health after HCV treatment is crucial for your long-term wellbeing. Your liver may continue to improve even after the virus is cleared, particularly if there was previous damage. Adopting healthy lifestyle choices can significantly support your liver's recovery and overall health.
Essential lifestyle recommendations include avoiding or limiting alcohol consumption, as alcohol can cause additional liver damage even after HCV cure. Maintain a healthy, balanced diet rich in fruits, vegetables, and whole grains whilst limiting processed foods and excessive fats. Regular physical activity can help maintain a healthy weight and improve overall liver function. It's also important to avoid unnecessary medications and supplements that may stress the liver, and always consult your healthcare provider before starting new medications. Stay up to date with vaccinations for hepatitis A and B, as these can cause additional liver complications if contracted.
