Adults should screen once for hepatitis C antibodies; if positive, get an RNA test, and if confirmed, complete an 8- to 12-week course of oral antivirals to achieve a cure in over 95% of cases

Hepatitis C virus (HCV) can silently damage the liver for decades without causing any symptoms; a simple antibody blood test, followed by an RNA test if positive, establishes the diagnosis. For those with active infection, an 8- to 12-week course of oral antivirals clears the virus in over 95% of cases. Achieving viral clearance cuts subsequent overall mortality risk by roughly 60% and liver cancer risk by around 70%. In China, national price negotiations incorporated these therapies into basic health insurance in 2019, slashing medication costs by over 85%.

An anti-HCV antibody blood test costs a few dozen yuan ($5–$15) out of pocket. If positive, a follow-up HCV RNA PCR test determines active viral infection. Confirmed patients obtain prescribed direct-acting antivirals (DAAs) at designated infectious disease clinics; most regimens consist of one tablet daily for 8 to 12 weeks, with medication costs largely covered by national health insurance. The primary challenge is that asymptomatic individuals rarely think to get tested.

Hepatitis C is a blood-borne viral infection with no preventive vaccine. The World Health Organization (WHO) notes that chronic hepatitis C typically remains asymptomatic for decades, often discovered only after severe liver fibrosis or cirrhosis develops. Antibody positivity reflects past exposure; an HCV RNA test is required to confirm whether active infection is present. Approximately 30% of infected individuals clear the virus spontaneously within 6 months without treatment. WHO states that direct-acting antivirals (DAAs) taken orally for 8 to 12 weeks cure almost all treated patients. An evidence review conducted for the USPSTF pooled 49 treatment trials: sustained virologic response (SVR, defined as undetectable HCV RNA 12 weeks post-treatment) exceeded 95% across all genotypes, with serious adverse events occurring in only 1.9% and discontinuation due to adverse effects in 0.4%. Pooling 13 observational cohort studies, achieving SVR was associated with a 60% reduction in all-cause mortality (adjusted HR 0.40, 95% CI 0.28–0.56) and a 71% reduction in hepatocellular carcinoma (adjusted HR 0.29, 95% CI 0.23–0.38 across 20 cohorts). In a French prospective cohort of 9,895 chronic HCV patients tracked for a median of 33.4 months, DAA therapy was associated with a 52% decrease in all-cause mortality (HR 0.48, 95% CI 0.33–0.70) and a 34% reduction in hepatocellular carcinoma (HR 0.66, 95% CI 0.46–0.93) after adjusting for age, fibrosis stage, and alcohol consumption. Among 15,059 U.S. veterans with advanced liver disease treated with DAAs (mean follow-up 1.6 years), mortality was 2.6 deaths per 100 person-years in those achieving SVR versus 12.3 in those who did not, representing a 74% reduction in risk (adjusted HR 0.26, 95% CI 0.22–0.31). The USPSTF (2020) recommends screening all adults aged 18 to 79 (Grade B), with a single lifetime screen sufficient for most people. Chinese 2022 guidelines recommend universal screening for all adults, regular screening for high-risk populations, and immediate RNA testing for all antibody-positive individuals. A 2006 national survey in China found an anti-HCV seroprevalence of 0.43% among ages 1–59; meta-analyses estimated 0.60% in the general population, 48.67% among people who inject drugs, and 6.59% among hemodialysis patients. China's National Healthcare Security Administration reported that before negotiation, full DAA treatment courses often exceeded 50,000 RMB; the 2019 national insurance catalog inclusion lowered prices by over 85%.

Controverted by Cochrane (2017), which restricts its evaluation strictly to randomized trials; finding that 138 trials were mostly short-term and assessed surrogate virologic clearance rather than clinical morbidities or long-term mortality, Cochrane asserted that whether SVR translates to reduced mortality has not yet been directly demonstrated in randomized controlled trials. Mortality and liver cancer data presented above originate from extensive prospective longitudinal observational cohorts. No trials directly randomize patients to screening versus no screening. High-risk populations designated for screening include individuals undergoing major surgery, blood transfusion, endoscopy, or hemodialysis; those with unexplained liver enzyme elevations; individuals with a history of intravenous drug use, paid plasma donation, multiple sexual partners, or men who have sex with men; people living with HIV; and regular sexual partners of HCV-infected individuals. In China, many chronic cases trace back to transfusions or plasma donations prior to 1993. Transmission can also occur through unsterilized tattooing, ear piercing, or shared razors and toothbrushes; casual contact (hugging, sharing utensils or cups) does not spread HCV. After successful treatment, antibody tests remain positive for life; RNA testing is required to verify cure or identify re-infection. Successful cure does not confer immunity against re-infection; active injection drug users should undergo annual RNA testing. If discovered during pregnancy, curative treatment is deferred until after delivery and cessation of breastfeeding; strict contraception is required during treatment. Patients with established cirrhosis require ongoing ultrasound surveillance for hepatocellular carcinoma even after viral clearance. Avoiding shared needles is detailed in Chapter 1, Rule 30. Hepatitis B requires a separate diagnostic panel, described in Chapter 1, Rule 14. HIV screening is discussed in Chapter 1, Rule 31. Guidelines caution that combining chronic HCV with excessive alcohol markedly accelerates progression to hepatic failure; alcohol limitations are detailed in Chapter 2, Rule 19. Primary beneficiaries are yourself, your spouse, and intimate partners.

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