Hepatitis C is a viral infection that primarily targets the liver, causing inflammation and potentially leading to serious liver damage over time. The Hepatitis C Virus (HCV) is a blood-borne pathogen that can cause both acute and chronic infections. When HCV enters the body, it specifically attacks liver cells, disrupting their normal function and triggering an inflammatory response. In many cases, the initial infection may go unnoticed as symptoms can be mild or absent entirely. However, if left untreated, chronic Hepatitis C can progress to severe complications including liver fibrosis, cirrhosis, liver failure, and hepatocellular carcinoma. The virus interferes with the liver's ability to process toxins, produce essential proteins, and regulate metabolism. Fortunately, modern direct-acting antiviral (DAA) treatments available in Australia have revolutionised HCV management, offering cure rates exceeding 95% with minimal side effects.
Australia predominantly sees HCV genotypes 1 and 3, which account for approximately 90% of all cases across the country. Genotype 1, particularly subtype 1a, is the most common strain, representing about 55% of infections. Genotype 3 follows as the second most prevalent, comprising roughly 35% of cases. Other genotypes, including 2, 4, 5, and 6, are less frequently encountered but still present within specific population groups. The distribution of genotypes can vary based on demographic factors and transmission routes. Understanding the specific genotype is crucial for treatment planning, as different genotypes may respond differently to various antiviral medications, though current DAA therapies are highly effective across all genotypes commonly found in Australia.
Hepatitis C transmission occurs primarily through blood-to-blood contact, with several key risk factors identified in the Australian context. The most common transmission routes include:
Sexual transmission is considered low risk but can occur, particularly among men who have sex with men or in the presence of other sexually transmitted infections. Unlike Hepatitis A and B, Hepatitis C cannot be transmitted through casual contact, sharing food, or saliva.
Acute Hepatitis C infection often presents with minimal or no symptoms, making early detection challenging. When symptoms do occur within the first six months, they may include fatigue, nausea, loss of appetite, muscle aches, and low-grade fever. Some individuals may experience jaundice, characterised by yellowing of the skin and eyes, along with dark urine and pale stools. Chronic Hepatitis C, which develops when the infection persists beyond six months, frequently remains asymptomatic for years or even decades. However, as liver damage progresses, chronic symptoms may gradually emerge including persistent fatigue, depression, cognitive difficulties often referred to as "brain fog," joint pain, and abdominal discomfort. Advanced chronic infection may lead to signs of liver dysfunction such as fluid retention, easy bruising, spider-like blood vessels on the skin, and enlarged spleen.
Australia's healthcare system provides comprehensive HCV testing through both public and private pathways. Initial screening involves HCV antibody testing, which detects exposure to the virus but doesn't distinguish between current and past infections. Confirmation requires HCV RNA testing (PCR), which identifies active infection by detecting viral genetic material. Additional tests include genotyping to determine the specific strain, liver function tests to assess organ damage, and FibroScan or liver biopsy to evaluate fibrosis levels. These tests are readily available through GP referrals, sexual health clinics, and specialist hepatology services, with Medicare providing substantial coverage for diagnostic procedures.
Testing should be considered if you have any risk factors for HCV exposure or experience unexplained symptoms suggestive of liver dysfunction. The Australian government recommends routine testing for individuals born between 1945-1965, people who have injected drugs, received blood transfusions before 1990, or have other identified risk factors. Immediate medical attention should be sought if experiencing jaundice, severe fatigue, abdominal pain, or signs of advanced liver disease. Regular monitoring is essential for diagnosed individuals, even if asymptomatic, as treatment can prevent progression to serious complications.
Direct-acting antivirals (DAAs) represent the gold standard for hepatitis C treatment in Australia, offering remarkable cure rates exceeding 95% for most patients. These medications work by targeting specific proteins essential for HCV replication, effectively stopping the virus from reproducing in the body. DAAs have revolutionised hepatitis C treatment since their introduction, replacing older interferon-based therapies that had significant side effects and lower success rates. Modern DAA regimens are typically well-tolerated, with minimal adverse effects compared to previous treatments. The high efficacy of these medications has made hepatitis C a curable condition for the vast majority of patients, regardless of genotype or previous treatment history. Australian treatment guidelines strongly recommend DAA therapy as first-line treatment for all eligible patients with chronic hepatitis C infection.
The Australian Government provides comprehensive PBS coverage for hepatitis C medications, making treatment accessible to all eligible patients regardless of their financial circumstances. Since March 2016, DAA medications have been available through the PBS with standard co-payment rates for concession card holders and general patients. This landmark decision has removed financial barriers to treatment, enabling Australia to work towards the World Health Organisation's goal of eliminating hepatitis C as a public health threat by 2030. PBS coverage extends to all approved DAA combinations and is available through both hospital and community pharmacy settings, ensuring widespread access to these life-saving medications across urban and rural Australia.
Modern DAA therapies typically require 8-12 weeks of treatment, representing a significant reduction from previous treatment durations. Cure rates, measured as sustained virologic response (SVR), consistently exceed 95% across all hepatitis C genotypes when patients complete their prescribed course. Treatment duration may vary based on factors such as HCV genotype, presence of cirrhosis, and previous treatment history. Some patients may qualify for shortened 8-week courses, whilst others with more complex cases may require 12-week regimens. The combination of short treatment duration and high cure rates has transformed patient outcomes and quality of life for those living with hepatitis C.
Sofosbuvir-based combinations are cornerstone treatments for hepatitis C in Australia, with Harvoni (sofosbuvir/ledipasvir) and Epclusa (sofosbuvir/velpatasvir) being the most widely prescribed options. Harvoni is indicated for genotypes 1, 4, 5, and 6, whilst Epclusa offers pan-genotypic coverage for all HCV genotypes 1-6. These once-daily oral medications are suitable for treatment-naïve and treatment-experienced patients, including those with compensated cirrhosis. Epclusa is particularly valuable in clinical practice due to its pan-genotypic efficacy, eliminating the need for genotype testing in many cases. Both medications demonstrate excellent tolerability profiles with minimal drug interactions. Treatment courses typically range from 8-12 weeks depending on patient characteristics and disease factors.
Maviret (glecaprevir/pibrentasvir) is a pan-genotypic DAA combination offering highly effective treatment for all HCV genotypes. The standard treatment duration is 8 weeks for most treatment-naïve patients without cirrhosis, making it one of the shortest available regimens. Patients with cirrhosis or previous treatment experience may require 12-week courses. Maviret is particularly beneficial for patients seeking shorter treatment duration whilst maintaining high cure rates exceeding 95%. The medication is contraindicated in patients with moderate to severe hepatic impairment (Child-Pugh B or C) and requires careful consideration of drug interactions, particularly with certain cardiac and seizure medications.
Additional DAA options available in Australia include ribavirin for combination therapy in complex cases and various other sofosbuvir-containing regimens. These medications serve specific roles in treating patients with:
Selection of alternative therapies typically requires specialist hepatology consultation to ensure optimal treatment outcomes and appropriate monitoring protocols.
Modern direct-acting antiviral (DAA) regimens typically produce mild and transient side effects. Patients may experience fatigue, headache, nausea, insomnia, or mild gastrointestinal upset during treatment. More significant symptoms such as allergic reactions, mood changes, or liver enzyme elevations occur rarely but require immediate medical attention.
Effective management strategies focus on symptomatic care and patient education:
Maintaining treatment adherence despite mild side effects is crucial for maximising cure rates. Patients should be educated about warning signs including jaundice, severe abdominal pain, or signs of hypersensitivity reactions that warrant immediate medical review. Most side effects resolve completely after treatment completion, and regular follow-up contact helps address patient concerns whilst ensuring successful treatment completion.
DAA regimens can interact significantly with prescription medications, over-the-counter products, and herbal supplements, potentially altering drug levels and compromising safety. Common interactions occur with anticonvulsants, rifamycins, certain statins, St John's wort, and medications affecting cytochrome P450 enzymes or drug transporters.
Comprehensive medication screening before initiating therapy is essential for patient safety. Certain regimens are contraindicated in patients with decompensated cirrhosis or when combined with medications that increase hepatotoxicity risk. Special pregnancy considerations apply, as ribavirin is teratogenic and requires strict contraceptive measures. Healthcare providers should consult current interaction resources and seek specialist advice when uncertainty exists, particularly for complex medication regimens.
Treatment monitoring involves systematic assessment of virologic response and patient safety. Baseline and on-treatment HCV RNA testing documents virologic response, whilst liver function tests and renal function assessments monitor organ health. Complete blood counts are recommended when ribavirin forms part of the treatment regimen.
Clinical review early in therapy addresses treatment adherence and side effect management. Additional visits or remote consultations occur mid-treatment and at therapy completion. Post-treatment testing at 12 weeks confirms sustained virologic response, indicating cure, followed by ongoing liver health assessment for long-term patient wellbeing.
Hepatitis C prevention centres on reducing blood-borne exposure through comprehensive harm reduction strategies. For people who inject drugs, evidence-based interventions include access to sterile injecting equipment through needle and syringe programs, opioid agonist therapy to reduce injecting frequency, safe disposal services, and education on safer injecting practices.
Healthcare settings require strict adherence to safe practices including single-use equipment, rigorous sterilisation protocols, and comprehensive screening of blood products to prevent iatrogenic transmission. Whilst sexual transmission remains relatively low, risk increases with HIV coinfection or traumatic sexual practices, making condom use advisable in higher-risk situations. Routine screening of at-risk populations enables early detection and treatment, supporting both individual health outcomes and public health elimination goals.
Australia provides comprehensive support services for hepatitis C patients through multiple healthcare pathways. Primary care clinicians and specialist hepatology or infectious disease clinics deliver expert medical management, whilst community health centres, Aboriginal and Torres Strait Islander health services, and sexual health clinics offer accessible testing and culturally appropriate care.
Additional support includes needle and syringe programs, opioid agonist treatment clinics, and peer-led organisations providing harm reduction resources. Patient advocacy groups, counselling services, and mental health providers address psychosocial needs. Specialised services offer treatment navigation, care linkage, and assistance accessing Pharmaceutical Benefits Scheme subsidies, ensuring equitable access to life-saving therapy across diverse Australian communities.
Following successful hepatitis C cure, patients require ongoing liver assessment to monitor fibrosis regression and hepatocellular carcinoma risk, particularly if advanced fibrosis was present. Regular surveillance continues for patients with cirrhosis, ensuring early detection of potential complications.
Lifestyle recommendations support long-term liver health and overall wellbeing:
Regular follow-up ensures prompt identification and treatment of potential reinfection, maintaining the health benefits achieved through successful hepatitis C treatment whilst supporting Australia's elimination goals.
