Hepatitis C, sometimes also called hep C or HCV, is a virus that causes damage to the liver. It is transmitted by blood-to-blood contact, most commonly by sharing of needles and syringes in injecting drug use, but also in other bloody events in the prison setting such as tattooing and fights. Hep C can cause an acute illness (‘hepatitis’) when someone first becomes infected, but is more commonly acquired without any apparent illness. In about three of four individuals who become infected the virus is not cleared by the immune system and the infection becomes chronic, which means it will stay for life unless antiviral treatment is provided. Chronic hep C infection is also typically silent – that is most individuals are unaware that they have it unless the infection is identified in blood tests looking for antibodies against the virus (which means they have been infected at some time) and for the genetic material of the virus (RNA – which means ongoing infection) detected by a PCR test. The infection causes inflammation in the liver which is reflected in abnormalities in a set of blood tests called liver function tests. Over many years or decades, the ongoing inflammation in the liver caused by the virus, causes build-up of scarring (also called ‘fibrosis’).

When the build-up of scar tissue is very advanced and there is very little normal liver remaining this is called cirrhosis. In this stage, the liver stops being able to do its key jobs: making new proteins such as blood clotting factors; clearing out waste materials from the day-to-day processes of all cells in the body; warehousing energy stores; and breaking down (‘metabolising’) foods and drugs. When this happens it is called ‘liver failure’ and it is fatal unless a liver transplant is provided.

In the last few years, almost miraculous drug treatments for hep C have been developed – these are called direct acting antivirals (DAAs). The DAAs can cure essentially everyone with chronic hep C (and stop the progression of liver scarring). The drugs are also equally effective if someone becomes re-infected and is treated for the second or third time. With these drugs the World Health Organisation hopes to eliminate hep C as a public health concern worldwide.