Get one hepatitis C antibody test as an adult; if positive, get a nucleic acid test, and if confirmed, take an oral drug for 8 to 12 weeks, which cures the great majority

Cost

A hepatitis C antibody test is one blood draw and usually costs a few dozen CNY out of pocket, with prices varying by place. If the antibody is positive, another blood draw for a nucleic acid test shows whether the virus is still there. People with a confirmed diagnosis get the drug at a designated local hepatitis C hospital; most regimens are 1 pill a day for 8 to 12 weeks, and the drug cost is reimbursed by medical insurance. The hard part is remembering to get tested when you have no symptoms.

What you get

Hepatitis C spreads through blood, and there is no vaccine. The World Health Organization says chronic hepatitis C often has no symptoms for decades, and by the time symptoms appear the liver is already badly damaged. A positive antibody only shows past infection; a nucleic acid test is needed to know whether the virus is still there. About 30% of people don't need treatment after infection, because their bodies clear the virus on their own within 6 months. The World Health Organization says that oral direct-acting antiviral drugs for 8 to 12 weeks cure almost all patients. An evidence review done for the U.S. Preventive Services Task Force pooled 49 treatment studies, and the cure rate was at least 95% for every genotype. Cure means no virus can be found in the blood 12 weeks after stopping the drug. Serious adverse effects were 1.9%, and stopping the drug because of side effects was 0.4%. The same review also pooled follow-up record studies, which had no assigned comparison groups. Compared with people who were not cured, those cured had about 60% lower total mortality (HR 0.40, 95% CI 0.28–0.56, 13 studies). Liver cancer was about 71% lower (HR 0.29, 95% CI 0.23–0.38, 20 studies). France followed 9895 patients with chronic hepatitis C for a median of 33.4 months. After accounting for age, degree of liver fibrosis, drinking and other factors, people who took the drugs had about 52% lower total mortality (HR 0.48, 95% CI 0.33–0.70). Liver cancer was about 34% lower (HR 0.66, 95% CI 0.46–0.93). Among U.S. veterans, 15059 hepatitis C patients with liver disease already at an advanced stage took these drugs. Followed for about 1.6 years on average, 2.6 people per 100 people followed for a year died among the cured, versus 12.3 among those not cured. After accounting for other factors, the risk of death was about 74% lower (HR 0.26, 95% CI 0.22–0.31). In 2020 the U.S. Preventive Services Task Force recommended that all adults aged 18 to 79 be tested (grade B). For most people, one test in a lifetime is enough. China's 2022 prevention and treatment guideline advises antibody screening for all adults, regular testing for people who stay at high risk, and a nucleic acid test for everyone with a positive antibody. In a 2006 national survey, the antibody-positive rate in people aged 1 to 59 was 0.43%. Pooling multiple studies, it was 0.60% in the general population, 48.67% in people who use drugs, and 6.59% in people on hemodialysis. The National Healthcare Security Administration (国家医保局) said that before the negotiations, a course of hepatitis C drugs mostly cost more than 50,000 (5万) CNY. The three hepatitis C drugs that entered medical insurance through negotiation in 2019 had prices cut by 85% or more on average (U.S., France / China)

Notes

Dispute: the Cochrane review of 2017 accepts only randomized trials. The 138 trials it found were mostly short-term, and could not judge whether these drugs mean fewer deaths or less liver disease. It holds that “cure” only means no virus is found in the blood, and the link between that and fewer deaths has not been confirmed by randomized trials. The death and liver cancer numbers above all come from follow-up records. No study has directly compared testing with not testing. The national program names these people for testing: those about to have surgery, a blood transfusion, an endoscopy or dialysis, and those with unexplained abnormal liver function tests; those who have injected drugs, sold blood plasma, had multiple sex partners, or had sex between men; people with HIV, and the spouses and sex partners of hepatitis C patients. The program also proposes encouraging people 40 and older to get tested. The guideline states that most current patients had blood transfusions or sold blood plasma before 1993. Tattoos, ear piercing, and sharing razors and toothbrushes can also spread it. Hugging and sharing bowls, chopsticks and cups generally do not. After a cure the antibody stays positive, so only a nucleic acid test shows whether you have been infected again. You can be infected again after being cured, and people who still share needles should get a nucleic acid test at least once a year. If it is found during pregnancy, treat after giving birth and after you stop breastfeeding, and use contraception during treatment. People who already have cirrhosis still need scheduled liver cancer checks even after a cure. For not sharing needles, see §1.30 (don't share needles with anyone). Hepatitis B is tested with a different set of markers; see §1.14 (get the hepatitis B two-and-a-half tests). For HIV, see §1.31 (get an HIV test once). The guideline states that hepatitis C plus heavy drinking can progress to liver failure; for drinking, see §2.19 (drink little or no alcohol). The beneficiary is mainly you, and it also protects your spouse and sex partners.

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

1. US Preventive Services Task Force, Owens DK, Davidson KW, et al. (2020). Screening for Hepatitis C Virus Infection in Adolescents and Adults: US Preventive Services Task Force Recommendation Statement. JAMA, 323(10), 970-975. https://doi.org/10.1001/jama.2020.1123
2. Chou R, Dana T, Fu R, Zakher B, Wagner J, Ramirez S, Grusing S, Jou JH (2020). Screening for Hepatitis C Virus Infection in Adolescents and Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. https://doi.org/10.1001/jama.2019.20788
3. Carrat F, Fontaine H, Dorival C, et al. (2019). Clinical outcomes in patients with chronic hepatitis C after direct-acting antiviral treatment: a prospective cohort study. The Lancet, 393(10179), 1453-1464. https://doi.org/10.1016/S0140-6736(18)32111-1
4. Backus LI, Belperio PS, Shahoumian TA, Mole LA (2019). Impact of Sustained Virologic Response with Direct-Acting Antiviral Treatment on Mortality in Patients with Advanced Liver Disease. Hepatology, 69(2), 487-497. https://doi.org/10.1002/hep.29408
5. Jakobsen JC, Nielsen EE, Feinberg J, et al. (2017). Direct-acting antivirals for chronic hepatitis C. Cochrane Database of Systematic Reviews, CD012143.pub3. https://doi.org/10.1002/14651858.CD012143.pub3（反方）
6. World Health Organization (2026). Hepatitis C（事实清单，2026-07-28）. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c
7. 中华医学会肝病学分会, 中华医学会感染病学分会 (2022). 丙型肝炎防治指南（2022 年版）. 中华肝脏病杂志, 30(12), 1332-1348. https://doi.org/10.3760/cma.j.cn501113-20221220-00605
8. 国家卫生健康委办公厅等九部门 (2021). 关于印发消除丙型肝炎公共卫生危害行动工作方案（2021-2030 年）的通知（国卫办疾控函〔2021〕492 号）. https://www.nhc.gov.cn/jkj/c100062/202109/6bf87bfeb2f0424e8d6efc0425b91699.shtml
9. 国家医疗保障局 (2019). 《关于将 2019 年谈判药品纳入乙类范围的通知》政策解读. https://www.nhsa.gov.cn/art/2019/11/28/art_53_2057.html

Translated from the Chinese original. Original book, section 1, tip 45. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer