Hepatitis C is a viral infection that specifically targets the liver, causing inflammation and potentially serious long-term health complications. The hepatitis C virus (HCV) is a bloodborne pathogen that can lead to both acute and chronic liver disease. When HCV enters the body, it attacks liver cells, causing inflammation and scarring over time. In many cases, the infection becomes chronic, meaning it persists for more than six months. Chronic hepatitis C can progressively damage the liver, potentially leading to cirrhosis, liver failure, or hepatocellular carcinoma. The virus interferes with normal liver function, affecting the organ's ability to filter toxins, produce essential proteins, and store energy. Early detection and treatment are crucial for preventing serious liver damage and maintaining overall health.
Hepatitis C transmission occurs primarily through contact with infected blood. In Australia, the most common transmission routes include sharing needles or other drug-injecting equipment, receiving blood transfusions before 1990, and sharing personal items like razors or toothbrushes with infected individuals. Healthcare workers face occupational exposure risks through needlestick injuries. Less common transmission methods include unsterile tattooing or body piercing procedures, and rarely, sexual transmission. Mother-to-child transmission during childbirth is possible but uncommon. People who inject drugs, received blood products before screening protocols, have HIV infection, or were born in countries with high HCV prevalence face elevated risks. Aboriginal and Torres Strait Islander communities experience disproportionately higher infection rates, making targeted screening and prevention efforts particularly important in these populations.
Hepatitis C infection progresses through distinct stages, often without noticeable symptoms in early phases. Acute hepatitis C, occurring within the first six months, frequently presents no symptoms, though some individuals may experience fatigue, nausea, loss of appetite, mild abdominal pain, or jaundice. Approximately 15-25% of people clear the virus naturally during this acute phase. Chronic hepatitis C develops when the infection persists beyond six months, affecting 75-85% of infected individuals. Chronic stage symptoms may include persistent fatigue, joint pain, difficulty concentrating, and depression. As liver damage progresses, symptoms become more pronounced, including abdominal swelling, dark urine, pale stools, and increased bruising. Advanced stages may lead to cirrhosis complications such as portal hypertension, varices, and liver failure. Many Australians remain unaware of their infection for years, emphasising the importance of regular testing for at-risk populations.
Hepatitis C diagnosis involves a two-step testing process available through Australian healthcare providers. Initial screening uses an HCV antibody test, which detects antibodies produced in response to hepatitis C infection. This blood test indicates whether someone has ever been exposed to the virus. If antibodies are detected, a confirmatory HCV RNA test (also called PCR test) determines if the virus is currently active in the bloodstream. The RNA test measures viral load and confirms chronic infection. Additional tests may include liver function tests to assess organ damage and genotype testing to identify the specific strain. These diagnostic procedures are typically performed in pathology laboratories and results are usually available within a few days to a week.
Regular hepatitis C testing is recommended for high-risk populations and specific circumstances. Individuals should seek testing if they have injected drugs, received blood transfusions before 1990, have HIV infection, or engage in high-risk activities. Healthcare guidelines recommend routine screening for Aboriginal and Torres Strait Islander people, individuals with elevated liver enzymes, and those born in high-prevalence countries. Annual testing is advisable for people who continue injecting drugs or have ongoing risk factors. Pregnant women and healthcare workers following needlestick injuries should also undergo testing.
Hepatitis C test results provide crucial information for treatment planning and monitoring. A positive antibody test with negative RNA indicates past infection that has cleared naturally or through treatment. Positive results for both antibody and RNA tests confirm active chronic hepatitis C requiring treatment. Viral load measurements help monitor treatment response and determine cure rates. HCV genotype testing identifies specific virus strains, which influences treatment selection. Australia commonly sees genotypes 1, 2, and 3, with different genotypes responding variably to treatments. Key genotype considerations include:
Understanding these results helps healthcare providers develop personalised treatment strategies and monitor cure rates effectively.
Direct-Acting Antiviral (DAA) medications represent a revolutionary advancement in hepatitis C treatment, offering highly effective and well-tolerated therapeutic options for Australian patients. These modern treatments target specific proteins essential for HCV replication, achieving cure rates exceeding 95% across all genotypes. Unlike previous interferon-based therapies, DAAs are administered orally with minimal side effects and significantly shorter treatment durations. The Therapeutic Goods Administration (TGA) has approved several DAA combinations that provide personalised treatment approaches based on HCV genotype, previous treatment history, and patient-specific factors. These medications have transformed hepatitis C from a chronic, progressive condition into a curable disease, making treatment accessible to a broader range of patients including those with advanced liver disease, HIV co-infection, and other comorbidities.
Sofosbuvir, marketed as Sovaldi, forms the backbone of several highly effective HCV treatment regimens available through the PBS. This nucleotide analogue inhibitor is commonly combined with other DAAs such as velpatasvir (Epclusa) or ledipasvir (Harvoni) to create pangenotypic treatments effective against all HCV genotypes. Sofosbuvir-based combinations offer excellent tolerability profiles with minimal drug interactions, making them suitable for patients with complex medical histories. These treatments typically achieve sustained virological response rates of 95-99% across different patient populations. The availability of fixed-dose combination tablets containing sofosbuvir enhances treatment adherence and simplifies dosing regimens for both patients and healthcare providers throughout Australia.
Maviret, containing glecaprevir and pibrentasvir, represents a pangenotypic DAA combination approved for treating all major HCV genotypes in Australia. This once-daily, fixed-dose combination offers exceptional efficacy with cure rates exceeding 95% in treatment-naïve and treatment-experienced patients. Maviret is particularly advantageous for patients with mild to moderate kidney impairment, as it doesn't require dose adjustments. The treatment is well-tolerated with minimal side effects, primarily fatigue and headache. Its pangenotypic activity eliminates the need for genotype testing in most cases, streamlining treatment initiation and reducing healthcare costs across Australian treatment centres.
Modern HCV treatments in Australia typically require 8-12 weeks of daily oral medication, representing a significant reduction from previous treatment durations. Treatment length depends on specific factors including HCV genotype, presence of cirrhosis, and previous treatment history. Most patients achieve sustained virological response (SVR) rates of 95-99%, indicating permanent cure of hepatitis C infection. Shortened 8-week regimens are often suitable for treatment-naïve patients without cirrhosis, whilst 12-week courses may be recommended for more complex cases. Regular monitoring through pathology testing ensures treatment effectiveness, with SVR12 (undetectable viral load 12 weeks post-treatment) confirming successful cure. These excellent outcomes have made hepatitis C elimination a realistic public health goal for Australia.
The Pharmaceutical Benefits Scheme (PBS) provides comprehensive subsidised access to hepatitis C treatments for eligible Australian residents, dramatically reducing treatment costs from tens of thousands to standard PBS co-payment amounts. All major DAA combinations including sofosbuvir-based therapies and Maviret are listed on the PBS, ensuring equitable access regardless of socioeconomic status. The PBS listing removes previous treatment restrictions that limited access based on disease severity or substance use history. This universal access approach supports Australia's commitment to hepatitis C elimination by 2030. Medicare Benefits Schedule (MBS) items also cover essential monitoring tests including HCV RNA quantification and genotyping. The PBS authority streamlined approval process enables rapid treatment initiation for eligible patients across metropolitan and regional Australia.
PBS eligibility for HCV treatment requires confirmed chronic hepatitis C infection through positive HCV RNA testing and Australian residency or eligible visa status. Prescriptions must be initiated by specialists including gastroenterologists, hepatologists, infectious disease physicians, or experienced general practitioners with appropriate training. Treatment can be prescribed in both public and private healthcare settings, including specialist hepatitis services and community-based programs. No restrictions exist based on previous substance use, alcohol consumption, or liver disease severity. Patients require baseline assessment including liver function tests and screening for hepatitis B co-infection. The streamlined PBS authority process typically allows same-day treatment commencement following specialist assessment and confirmation of eligibility criteria.
Under the PBS, eligible patients pay standard prescription co-payments rather than full commercial prices, making treatment highly affordable across all income levels. Additional support programs assist patients experiencing financial hardship or complex social circumstances. The following assistance options are available:
Many pharmaceutical companies offer patient assistance programs providing additional financial support or free medication in exceptional circumstances. State and territory health departments fund specialist hepatitis services that provide comprehensive care including treatment navigation, adherence support, and post-treatment monitoring to ensure optimal patient outcomes across diverse Australian communities.
Modern hepatitis C treatments, particularly direct-acting antivirals (DAAs), are generally well-tolerated with mild side effects. The most frequently reported symptoms include fatigue, headache, nausea, and mild gastrointestinal upset. Some patients may experience insomnia, irritability, or dizziness during treatment. These side effects are typically temporary and resolve once treatment is completed. Most patients can continue their daily activities normally whilst taking HCV medications.
HCV medications can interact with various drugs, including certain antacids, seizure medications, and some heart medicines. It's crucial to inform your pharmacist and doctor about all medications, supplements, and herbal products you're taking before starting treatment. Some interactions may require dose adjustments or alternative medications. Always consult your healthcare provider before starting any new medication during HCV treatment to ensure safe and effective therapy.
Regular monitoring is essential throughout HCV treatment to ensure effectiveness and safety. Your doctor will typically schedule blood tests at 4, 8, and 12 weeks during treatment to monitor viral levels and liver function. A sustained virological response (SVR) test is conducted 12 weeks after treatment completion to confirm cure. Follow-up appointments may include ongoing liver health monitoring, especially for patients with cirrhosis or other liver complications. Your healthcare team will create a personalised monitoring schedule based on your specific treatment regimen and health status.
Hepatitis C spreads through blood-to-blood contact, so preventing transmission involves avoiding shared use of items that may contain blood. Never share needles, razors, toothbrushes, or personal grooming items. Cover any cuts or wounds with bandages and clean blood spills with bleach solution. Hepatitis C is not spread through casual contact, sharing food, or hugging. Sexual transmission is possible but uncommon. Practice safe sex and inform sexual partners about your status to make informed decisions together.
Maintaining a healthy lifestyle supports liver health and treatment success. Avoid alcohol completely during treatment and limit consumption afterwards, as alcohol can worsen liver damage. Follow a balanced diet rich in fruits, vegetables, and whole grains whilst limiting processed foods. Regular exercise, adequate sleep, and stress management contribute to overall wellbeing. Stay hydrated and avoid unnecessary medications that may stress the liver. These healthy habits benefit both treatment outcomes and long-term liver health.
Australia offers comprehensive support for people with hepatitis C through various services and organisations. Key resources include:
Most treatments are subsidised through the PBS, making them accessible to all Australians. Your local pharmacy can connect you with appropriate healthcare services and support networks in your area.
