Ep 200 – Hepatitis C

Hepatitis C was once considered a chronic, life-limiting condition with difficult treatments and significant stigma. Today, it is one of the great success stories of modern medicine: curable in the vast majority of patients with short courses of well-tolerated oral therapy. Yet, thousands of people in the UK remain undiagnosed. In this first episode of a series on hepatology and hepatitis, Dr James Waldron is joined by Dr Rik Fijten (GP Partner, Hepatitis C GP Champion for Bexley and GP Clinical Fellow in Gastroenterology) to explore why hepatitis C matters to primary care now more than ever. Together, they discuss who should be tested, how to interpret results, what happens after diagnosis and the central role GPs play in the NHS Hepatitis C Elimination Programme. This practical, confidence-building conversation focuses on normalising testing, reducing stigma and being curious, helping primary-care clinicians identify patients who could benefit from life-changing treatment.

Key take-home points

• Hepatitis C is an RNA virus that can lead to fibrosis, cirrhosis and hepatocellular carcinoma if left untreated, but it is now curable in most cases.
• Many people with hepatitis C are asymptomatic, meaning diagnosis often depends on clinician curiosity rather than patient presentation.
• Chronic infection requires treatment, though some patients will clear the disease spontaneously after an acute phase.
• Key risk factors include current or past injecting drug use, homelessness, imprisonment, men who have sex with men, sex work, birth in higher-prevalence regions and blood transfusions before 1996.
• Patients may not volunteer risk factors; normalising conversations and avoiding stigma improves disclosure and engagement.
• Hepatitis C testing should be considered after possible exposure, when reviewing abnormal liver function tests and opportunistically in patients with risk factors.
• Hepatitis C antibody positivity indicates past exposure; RNA positivity confirms active infection and the need for referral and treatment.
• Modern direct-acting antiviral treatments are oral, usually taken for 12 weeks, have minimal side effects and achieve cure rates of 98–99%.
• Primary care plays a key role in the Hepatitis C Elimination Programme by identifying undiagnosed patients and linking them to care.
• Cure does not prevent reinfection; patients with ongoing risk factors should be retested when appropriate.

Helpful resources

1. NHS. 2021. https://www.nhs.uk/conditions/hepatitis-c/.
2. Hepatitis C Trust. https://www.hepctrust.org.uk/.
3. World Health Organisation. 2025. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c.
4. HVC Action. 2025. https://www.hepctrust.org.uk/wp-content/uploads/2025/07/Sustaining-Success-Principles-to-achieve-and-maintain-hepatitis-C-elimination-in-England-The-Hepatitis-C-Trust-2025.pdf.