From Cross-Contamination to Cure: Hepatitis C

Medical progress in America has been astounding in the past few generations. A notable example of medical progress is the drop in cross-contamination between patients. Many people were unnecessarily infected with bloodborne diseases in their attempts to get medical treatment from the 50s and 70s due to the reuse of medical needles and poor screening of blood transfusions. The use of disposable needles and advances in the understanding of sterilization and screening since the 1950s-70s have all but eliminated the risks of cross-contamination in the United States, but for many, the damage was already done. Blood-borne viruses like hepatitis C had already infected millions.

Hepatitis C is an RNA virus that circulates in the blood.^[1] It primarily affects the liver (hepat- is from the Greek word for liver) and is one of the most common reasons for liver transplant in the United States.^[1] Many studies estimate that around 3 million Americans are infected, but many people are unaware of their infection, and studies do not always include people in places like prisons and mental institutions, which have very high rates.^[1,2] According to Dr. Nikhil Kapila on the MedEvidence Podcast, the United States “now recommends that all adults over the age of 18 get tested at least once for hepatitis C. So your primary care doctor should be approaching you about getting tested for hepatitis C.”^[3] Three in four people with hepatitis C were born between 1945 and 1965, exemplifying the high rates of cross-contamination in community inoculation programs before the modern era.^[2] Thanks to improvements in sanitation and screening, the risk of hepatitis C transmission through medical procedures has significantly declined. Currently, the highest risk of contracting hepatitis C is from illicit injected drugs, with some studies showing over 45% of adult injected drug users may have hepatitis C.^[1,2] Higher rates are found in males, African Americans, and Hispanic Americans.^[2]

Viruses like hepatitis C cause damage by reproducing. They infect a host cell and hijack the cell’s own machinery to produce so many virus particles that the cells burst and die. With hepatitis C, the primary cells infected are located in the liver, which is responsible for functions such as regulating and filtering blood, processing nutrients, and producing digestive fluids. The liver is particularly good at regenerating, however, and many patients remain symptom-free for years.^[1] Long-term hepatitis C infections are called chronic hepatitis C, and over time, the chance of liver damage increases. Chronic hepatitis C can cause liver damage in the form of fibrosis and/or cirrhosis and is a leading cause of liver cancer.^[1.2,4] Symptoms of hepatitis C include dark urine, fatigue, jaundice, flu-like symptoms, abdominal pain, and weight loss.^[1]

Treatments for hepatitis C have taken a path quite the opposite of popular music (in my unbiased opinion) and have gotten better and better through the generations. There are no vaccines that can prevent hepatitis C, but medications to treat the infection have come a long way. From the 1990s to the 2010s, our best treatment was interferon, a type of signaling molecule produced by the body to fight viruses.^[4] Interferon worked for some patients, but had a long treatment time, heavy side effects, and a limited response, especially in Black Americans.^[4,5] According to Dr. Kapila, “over the past five or 10 years, there's been a tremendous amount of research in the hepatitis C world, and they have very effective antiviral agents that cure hepatitis C with an almost 99% cure rate, which is just remarkable.”^[3] These medications, which disrupt the ability for viruses to create the proteins they need, are called direct-acting antiviral agents.^[5] Direct-acting antiviral agents tend to have fewer side effects and shorter treatment periods, which helps keep people adhering to the medications.^[5] There is still a need for new medications, however, as there continue to be drug/drug interactions and some issues when patients already have liver damage or other diseases like HIV.^[6] Clinical trials are ongoing to find new treatments for hepatitis C to leave this disease solidly in the past.

Creative Director Benton Lowey-Ball, BS, BFA

References:

^[1] Khalili, M., & Burman, B. (2014). Liver disease. In Hammer, G. D., & McPhee, S. J. (Eds.). Pathophysiology Of Disease An Introduction To Clinical Medicine (7th ed., pp. 385-425). McGraw-Hill Education.https://archive.org/details/PathophysiologyOfDiseaseAnIntroductionToClinicalMedicine7thEdPDFtahir99VRG/page/410/mode/1up?view=theater

^[2] Shiffman, M. (Ed.). (2012).  Chronic Hepatitis C Virus: Advances in Treatment, Promise for the Future. Springer Science+Business Media. DOI 10.1007/978-1-4614-1192-5_1 https://link.springer.com/book/10.1007/978-1-4614-1192-5

^[3] Koren, M.J. & Kapila, N. (Hosts). (2025). The liver: Common causes of complications, cirrhosis, and cancer. [Podcast Episode]. In MedEvidence! Truth Behind the Data. MedEvidence. https://www.buzzsprout.com/1926091/episodes/17268919

^[4] Rosen, H. R. (2011). Chronic hepatitis C infection. New England Journal of Medicine, 364(25), 2429-2438. https://www.nejm.org/doi/abs/10.1056/NEJMcp1006613

^[5] Oancea, C. N., Butaru, A. E., Streba, C. T., Pirici, D., Rogoveanu, I., Diculescu, M. M., & Gheonea, D. I. (2021). Global hepatitis C elimination: history, evolution, revolutionary changes and barriers to overcome. Romanian Journal of Morphology and Embryology, 61(3), 643. https://pmc.ncbi.nlm.nih.gov/articles/PMC8112794/

^[6] Good, S. S., Luo, S., Lin, K., Vo, A., Agrawal, N. G., & Sommadossi, J. P. (2025). Bemnifosbuvir and ruzasvir in combination exhibit potent synergistic antiviral activity in vitro while maintaining a favorable nonclinical safety profile in vivo. Antiviral Research, 237, 106137. https://www.sciencedirect.com/science/article/pii/S0166354225000634