Hepatitis C
Also called: hep C, HCV infection, hepatitis C virus infection, chronic hepatitis C
Hepatitis C is a liver infection spread through contact with infected blood, often from reused needles or unsafe injections. Most people feel well for years, so a blood test is the only way to know. A short course of tablets cures more than 95% of people.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Hepatitis C is an infection of the liver caused by the hepatitis C virus (HCV). It causes inflammation (swelling and irritation) of the liver. The virus lives in blood and spreads when blood from an infected person gets into another person's body, for example through a reused syringe, unclean medical or dental equipment, or blood that was not screened before a transfusion. It does not spread through hugging, kissing, breast milk, food or water.
About three in ten people who catch the virus clear it on their own within six months. The rest develop long-term (chronic) infection. Chronic hepatitis C usually causes no symptoms for many years, but over time it can scar the liver (cirrhosis) and lead to liver cancer. The World Health Organization (WHO) estimates that about 47 million people worldwide live with chronic hepatitis C, and the Eastern Mediterranean Region, which includes Pakistan, carries the largest share.
The good news is that hepatitis C can now be cured. Modern medicines called direct-acting antivirals (DAAs) are tablets taken as a short course, with few side effects, and they cure more than 95% of people. Because most people do not feel ill, testing is the key step. There is no vaccine, so preventing contact with infected blood is the only protection.
In Pakistan: what studies show
A 2007-2008 national survey found that 4.8% of people in Pakistan had hepatitis C antibodies, with Punjab highest at 6.7%, and a 2023 study estimated 9,746,000 people had active infection in 2021. In Sindh in 2019-2020, 10.8% of adults had antibodies, but only 25.9% of those who needed treatment said they had been treated.
- In Pakistan's only nationwide household survey (2007-2008), 4.8% of people tested positive for hepatitis C antibodies, meaning they had been infected at some point.[1] (national survey, data July 2007 - May 2008)
- In the same 2007-2008 national survey, Punjab had the highest rate of hepatitis C antibodies (6.7%), followed by Sindh (5.0%), with much lower rates in Balochistan and Khyber Pakhtunkhwa.[1] (national survey, data July 2007 - May 2008)
- A 2023 modelling study estimated that about 9,746,000 people in Pakistan were living with active (viraemic) hepatitis C as of 1 January 2021.[3] (modelled estimate, data estimate as of 1 January 2021)
- A review that pooled many Pakistan studies estimated that 6.2% of the general population had hepatitis C, which is higher than the 2007-2008 national survey figure.[2] (systematic review/meta-analysis, data studies published 1989 - April 2016)
- In a household survey across Sindh in 2019-2020, 10.8% of adults (397 out of 3,684) tested positive for hepatitis C antibodies.[4] (cross-sectional, data 1 Nov 2019 - 15 Jun 2020)
- In the same Sindh survey, only 25.9% of adults who needed hepatitis C treatment said they had ever been treated.[4] (cross-sectional, data 1 Nov 2019 - 15 Jun 2020)
- In the Sindh survey, adults who had received medical injections in the past year had about 1.5 times the odds of having hepatitis C antibodies, even after other factors were taken into account.[4] (cross-sectional, data 1 Nov 2019 - 15 Jun 2020)
- WHO and the Government of Pakistan say that about 110,000 people in Pakistan catch hepatitis C each year, mostly through unsafe medical injections.[5] (official report, data not stated)
Pakistan guidance: Provincial HCV Treatment Guidelines for Punjab (Technical Working Group for Punjab, Hepatitis Control Programme Punjab (published in JPMA), 2021)[6]
What we do not know yet: Pakistan's only nationwide hepatitis C survey is from 2007-2008; newer numbers come from provincial surveys (Punjab, Sindh) and models, and the Punjab guidelines report a rise in Punjab since 2008, but we could not open the newer Punjab survey itself. The 6.2% review estimate and the 4.8% national survey disagree, and no published counts yet show how many people have been tested, treated or cured under the Prime Minister's hepatitis C programme launched in 2025-2026.
Pakistan studies cited
- Qureshi H, Bile KM, Jooma R, et al. Prevalence of hepatitis B and C viral infections in Pakistan: findings of a national survey appealing for effective prevention and control measures. Eastern Mediterranean Health Journal (WHO EMRO) 2010;16(Supplement):S15-S23. Open source
- Al Kanaani Z, Mahmud S, Kouyoumjian SP, et al. The epidemiology of hepatitis C virus in Pakistan: systematic review and meta-analyses. Royal Society Open Science 2018. doi:10.1098/rsos.180257. Open source
- Mooneyhan E, Qureshi H, Mahmood H, et al. Hepatitis C prevalence and elimination planning in Pakistan, a bottom-up approach accounting for provincial variation. Journal of Viral Hepatitis 2023. doi:10.1111/jvh.13802. Open source
- Alamneh TS, Walker JG, Lim AG, et al. Hepatitis C virus cascade of care among adults in Sindh province, Pakistan: Findings from 2019-2020 household sero-survey. PLOS Global Public Health 2025. doi:10.1371/journal.pgph.0004706. Open source
- World Health Organization Pakistan; Ministry of National Health Services, Regulations and Coordination Pakistan, WHO launch Prime Minister's Hepatitis C Programme to reach 1.6 million people in Islamabad Capital Territory. WHO Regional Office for the Eastern Mediterranean (news release, 14 May 2026) 2026. Open source
- Technical Working Group for Punjab (Hepatitis Control Programme Punjab) Provincial HCV Treatment Guidelines for Punjab. Journal of the Pakistan Medical Association 2021;71(3). Open source
Symptoms
- Most people have no symptoms at all, especially in the early years
- Tiredness and feeling weak, which can become extreme if the infection is not treated
- Fever, loss of appetite, nausea (feeling sick) or vomiting
- Pain in the tummy (abdomen)
- Dark urine and pale stools (faeces)
- Joint pain
- Yellow skin or yellow whites of the eyes (jaundice)
- Itchy skin in long-standing infection
- Low mood, anxiety, or problems with memory and concentration in long-standing infection
Causes and risk factors
Causes
- Infection with the hepatitis C virus, which spreads when infected blood enters the bloodstream
- Reused or poorly sterilised syringes, needles and other medical, surgical or dental equipment
- Transfusion of blood or blood products that were not screened for the virus
- Sharing needles, syringes or other equipment used to inject drugs
- Shared razors (including at barber shops), toothbrushes, or unclean tattoo and piercing tools
- Less often, from mother to baby during pregnancy or birth, or through sex where blood is present
What makes it more likely
- Having had many injections, drips, operations or dental treatment where infection control may be poor
- Having received a blood transfusion from a blood bank that does not screen all donated blood
- Injecting drugs now or in the past
- Long-term kidney dialysis (haemodialysis)
- Working in health care and having a needlestick or sharps injury with infected blood
- Living with HIV
- Being born to a mother who has hepatitis C
- Being in prison or having repeated health-care procedures
Complications
If chronic hepatitis C is not treated, it slowly damages the liver. WHO estimates that 15 to 30 in every 100 people with chronic infection develop cirrhosis (severe scarring of the liver) within 20 years. People with cirrhosis have a yearly risk of liver cancer (hepatocellular carcinoma) of about 1 to 4 in 100. Drinking alcohol, or also having hepatitis B or HIV, can make liver damage happen faster. A small number of people need a liver transplant, and the infection can cause death. Hepatitis C can also affect other parts of the body, and is linked with diabetes, kidney inflammation (glomerulonephritis), a blood protein problem called cryoglobulinaemia, a skin condition called porphyria cutanea tarda, and a type of blood cancer (non-Hodgkin lymphoma).
When to see a doctor
- Yellow skin or eyes (jaundice), dark urine or pale stools: see a doctor promptly for liver tests
- Fever, tummy pain, vomiting and loss of appetite together with yellowing of the skin or eyes
- A needlestick or sharps injury, or a splash of blood into the eyes or mouth, from someone who may have hepatitis C: get tested as soon as possible
- Pregnancy when you have hepatitis C or may have been exposed: tell your doctor so you and your baby can be tested
- Side effects or feeling unwell during treatment, or blood tests that show the liver is getting worse: contact your specialist without delay
Diagnosis
Hepatitis C is found with blood tests, usually in two steps. The first is an antibody test, which shows whether you have ever been infected. If it is positive, a second test looks for the virus itself (HCV RNA). A positive RNA test means the infection is active and needs treatment. A positive antibody test with a negative RNA test usually means you were infected in the past and your body cleared the virus. The RNA test can find the virus one to two weeks after exposure, while antibodies can take two to three months to appear, so a test may need repeating after a recent risk. Both tests can be done in a laboratory or with quick point-of-care devices.
Before treatment, the doctor checks how much damage the liver has, using blood tests, a special scan or, rarely, a liver biopsy (a tiny sample of liver tissue). Other tests usually include liver blood tests, platelet count, hepatitis B and HIV tests, and a pregnancy test where relevant. WHO advises testing all adolescents and adults in countries where hepatitis C is common.
Treatment
- Confirm active infection with an HCV RNA test. Your doctor then checks your liver for scarring (cirrhosis), tests for hepatitis B and HIV, and reviews all other medicines you take, because some (for example certain acid-lowering medicines and some contraceptive pills) interact with hepatitis C tablets.
- Start a course of direct-acting antiviral (DAA) tablets that work against all types (genotypes) of the virus. WHO recommends these for everyone with chronic infection from age 3 upwards. In many low- and middle-income countries the most widely used low-cost combination is sofosbuvir with daclatasvir. Your doctor decides which medicines, the dose and how long to take them.
- Take every tablet until the course your doctor set is finished; people with cirrhosis may need a longer course. Most people have no side effects; a few feel tired, get headaches or feel sick. People with diabetes on insulin or some tablets should watch for low blood sugar, and people on warfarin need closer blood checks.
- Have a test of cure: an HCV RNA blood test about 12 weeks after the last tablet. If the virus is gone, you are cured. If it is still there, your specialist will choose a different treatment.
- People with cirrhosis that is getting worse, hepatitis B, previous hepatitis C treatment, serious kidney disease, liver cancer, a liver transplant, or pregnancy still need treatment, but under a specialist's care.
- Protect your liver during and after treatment: avoid alcohol or cut it down, keep a healthy weight and stop smoking.
- Avoid new exposure to blood. Being cured does not protect you from catching hepatitis C again.
Medicines in Pakistan
Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Direct-acting antivirals (separate tablets used together) | first-choice low-cost pangenotypic treatment, the most widely used combination in many low- and middle-income countries | Sofosbuvir (69 brands), Daclatasvir (53 brands) |
| Direct-acting antivirals (single combination tablet) | recommended pangenotypic treatment for adults with or without compensated cirrhosis | Sofosbuvir + Velpatasvir (33 brands) |
| Add-on antiviral | added by a specialist in some people with cirrhosis when the virus shows resistance; needs blood count checks because it can cause anaemia | Ribavirin (206 brands) |
Also used (not yet in our price list): Glecaprevir with pibrentasvir (combination tablet), another recommended pangenotypic treatment; not used in advanced (decompensated) cirrhosis
Self-care and prevention
Self-care
- Get tested if you have ever had an unsafe injection, a blood transfusion, dialysis or drug use, even if you feel well
- If you test positive, start treatment and take every tablet until the course is finished
- Go back for the test of cure about 12 weeks after the course ends
- Avoid alcohol or cut it down, keep a healthy weight and stop smoking to protect your liver
- Tell every doctor, dentist and pharmacist about all medicines you take, so they can check for interactions
- Do not share razors, toothbrushes or any injecting equipment
- Use condoms during sex, as blood can carry the virus
Prevention
- Make sure every injection is given with a new, sealed syringe and needle
- Accept a blood transfusion only from a blood bank that screens donated blood
- Use your own razor and toothbrush, and at the barber insist on a new blade
- Get tattoos and piercings only where equipment is sterile or single-use
- Never share needles, syringes or drug equipment; harm-reduction and needle exchange services help
- Health workers should handle and dispose of needles and sharps safely
Common questions
Can hepatitis C be cured?
Yes. A short course of direct-acting antiviral tablets cures more than 95% of people, whatever the type of virus. A blood test about 12 weeks after the course confirms the cure.
My antibody test is positive. Does that mean I have hepatitis C?
Not always. About three in ten people clear the virus on their own but stay antibody-positive for life. You need a second test for the virus itself (HCV RNA); only a positive RNA test means you have an active infection that needs treatment.
Can I catch hepatitis C from eating with someone or hugging them?
No. Hepatitis C is not spread by hugging, kissing, sharing food or drink, or breastfeeding. It spreads through blood, so do not share razors, toothbrushes or needles.
Is there a vaccine for hepatitis C?
No, there is no vaccine. The best protection is avoiding contact with infected blood, especially reused syringes and unscreened blood. Being cured once does not stop you catching it again.
Is there a government programme for hepatitis C in Pakistan?
Yes. The Prime Minister's National Programme for the Elimination of Hepatitis C, supported by WHO, aims to test 82.5 million people aged 12 and over and treat 5 million people by 2027. The goal is to end hepatitis C as a public health threat by 2030. Ask your doctor or local public hospital how to get tested.
Sources
- WHO. Hepatitis C (2026).
- CDC. Clinical Overview of Hepatitis C | Hepatitis C | CDC (2025).
- CDC. Clinical Screening and Diagnosis for Hepatitis C | Hepatitis C | CDC (2025).
- University of Washington Hepatitis C Online (summarising AASLD-IDSA HCV Guidance). Core Concepts - HCV Simplified Treatment - HCV Test and Cure - Hepatitis C Online (2025).
- NHS. Hepatitis C - NHS (2026).
- WHO EMRO. Pakistan, WHO launch Prime Minister's Hepatitis C Programme to reach 1.6 million people in Islamabad Capital Territory (2026).
- WHO EMRO. Testing and treatment bring new hope to hepatitis C patients in Pakistan (2025).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.