What is hepatitis C and how is it transmitted?

Hepatitis C is a blood-borne viral liver infection caused by hepatitis C virus (HCV) — one of the most important liver diseases globally, affecting 58 million people with chronic infection. Transmission: primarily through blood-to-blood contact: injection drug use (sharing needles — the dominant route in HICs); blood transfusion or medical procedures (pre-screening era — blood supply now safe in most countries); needlestick injuries in healthcare workers; vertical (mother-to-child) transmission; sexual transmission (MSM with HIV — higher risk than heterosexual). Unlike HBV, sexual transmission of HCV between heterosexual partners with no other risk factors is very rare.

What are the direct-acting antivirals (DAAs) and why are they revolutionary?

Until 2011, HCV treatment relied on ribavirin + interferon — causing severe side effects (depression, anaemia, flu-like symptoms) for 48 weeks with 40-80% cure rates depending on genotype. DAAs (direct-acting antivirals) completely transformed this: first-generation (2011-2014): genotype-specific, short course, 80-90% SVR. Pangenotypic DAAs (2016-present): two oral tablets daily for 8-12 weeks, >95% cure rate across all genotypes and liver disease stages, minimal side effects, no interferon. Sofosbuvir/velpatasvir (Epclusa) and glecaprevir/pibrentasvir (Maviret) are the main pangenotypic options, now generic in most countries.

Who should be tested for hepatitis C?

WHO recommends universal HCV testing for all adults (similar to HIV). Priority populations: people who inject or have ever injected drugs (PWID — highest risk); people born 1945-1965 in the US (the birth cohort with highest HCV prevalence from pre-screening era blood transfusions); HIV-positive individuals; people with liver disease of unknown cause; healthcare workers with needlestick history; incarcerated individuals; children of HCV-positive mothers.

Can hepatitis C be cured?

Yes — HCV is the only major viral infection currently curable with short-course oral therapy. Pangenotypic DAAs achieve a sustained virological response (SVR12 — undetectable HCV RNA 12 weeks after treatment end) in >95% of patients, including those with cirrhosis, HIV coinfection, previous treatment failure and transplanted patients. SVR12 is considered a cure — HCV cannot be detected, cannot transmit, and liver fibrosis often improves. Reinfection is possible after cure if risk behaviour continues — HCV re-treatment is equally effective.

Why does Georgia matter for hepatitis C?

Georgia is a global leader in HCV elimination. In 2015, Georgia launched the world's first national HCV elimination programme in a LMIC setting — in partnership with US CDC and Gilead Sciences, which donated sofosbuvir at no cost for the programme. By 2023, over 100,000 people had been treated, and HCV viremic prevalence had fallen dramatically. The Georgian programme demonstrated that HCV elimination is feasible in resource-limited settings with political will, donated medicines, simplified diagnostic algorithms and decentralised treatment delivery — it has been cited by WHO as a global model.

How does GMJ News cover hepatitis C?

GMJ News covers WHO HCV global burden, the DAA treatment revolution, Georgia's elimination programme, the missing millions challenge, HCV/HIV coinfection, pangenotypic regimens, treatment as prevention, and WHO 2030 elimination targets. Georgia's world-leading HCV elimination programme makes hepatitis C a topic of unique national pride and scientific significance for GMJ.

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Hepatitis C

GMJ News knowledge hub · last reviewed September 2026 · Georgian Medical Journal

Summary Statistics Glossary GMJ news FAQ Documents Organizations Research

Hepatitis C — caused by hepatitis C virus (HCV) — chronically infects 58 million people globally and kills approximately 290,000 per year from cirrhosis and hepatocellular carcinoma, yet is the subject of one of the most transformative treatment revolutions in medical history: pangenotypic direct-acting antivirals (DAAs) such as sofosbuvir/velpatasvir and glecaprevir/pibrentasvir now cure 95%+ of patients in 8-12 weeks with minimal side effects — making HCV the only major viral infection currently curable with short-course oral therapy (WHO). WHO elimination target by 2030 is achievable in many settings — but requires finding the “missing millions” undiagnosed in high-risk groups (people who inject drugs, incarcerated populations, migrants) and ensuring treatment access — a challenge where Georgia has made significant progress through national HCV elimination programmes.

Key messages

58M chronically infected — curable in 8-12 weeks

Hepatitis C virus (HCV) chronically infects 58 million people globally; 290,000 die each year from cirrhosis and HCC. Yet HCV is now the only major viral infection curable with short-course oral therapy — pangenotypic DAAs achieve 95%+ sustained virological response in 8-12 weeks (WHO).

Direct-acting antivirals (DAAs) — the revolution

Pangenotypic DAA regimens (sofosbuvir/velpatasvir; glecaprevir/pibrentasvir) treat all HCV genotypes without prior genotyping, in 8-12 weeks, with >95% cure rates and minimal side effects — one of the most transformative treatment developments in the history of medicine.

No vaccine — treatment as prevention

Unlike HBV, no vaccine exists for HCV. Prevention requires harm reduction (needle exchange, opioid agonist therapy), HCV screening, and treatment — as successfully treated individuals can no longer transmit HCV (treatment as prevention).

The missing millions — finding undiagnosed cases

Only approximately 22% of chronically infected people have been diagnosed; only 13% have been treated. The core challenge of HCV elimination: identifying the undiagnosed in high-risk populations (PWID, incarcerated, migrants, healthcare workers) and linking them to treatment.

HCV + HIV coinfection — accelerated disease

HCV/HIV coinfection — common among PWID — accelerates HCV-related liver fibrosis, cirrhosis and HCC. DAAs are equally effective in HCV/HIV coinfected patients. HIV treatment (ART) also slows HCV liver disease progression.

Georgia — global HCV elimination leader

Georgia launched the world's first national HCV elimination programme in 2015 (with CDC and Gilead support), providing free DAA treatment to over 100,000 people and achieving dramatic reductions in HCV prevalence — cited globally as a model for HCV elimination in LMIC settings.

Key statistics

58M

people chronically infected with HCV globally (WHO 2023)

WHO 2023

290K

HCV-related deaths/year (cirrhosis + HCC)

WHO

95%+

cure rate with pangenotypic DAAs in 8-12 weeks

WHO/EASL

55-85%

of HCV-exposed individuals develop chronic infection

WHO

22%

only 22% of chronically infected are diagnosed (WHO)

WHO 2023

2030

WHO HCV elimination target — Georgia a global model

WHO/CDC/Georgia

HCV treatment cascade — global 2022 (WHO)

Source: WHO 2022. The cascade shows the gap between infection and treatment at each step.

Glossary of key terms

Sustained virological response (SVR12)
WHO/EASLUndetectable HCV RNA (by sensitive PCR assay, limit of detection <15 IU/mL) at 12 weeks after completing a course of DAA therapy — equivalent to cure. SVR12 rates >95% with pangenotypic DAA regimens. Following SVR12: HCV cannot transmit to others; liver fibrosis often regresses; HCC risk markedly reduced.

Pangenotypic DAA regimens
WHO/EASLDirect-acting antivirals that treat all HCV genotypes (1-6) without prior genotyping: sofosbuvir/velpatasvir (Epclusa, Gilead) — 12 weeks; glecaprevir/pibrentasvir (Maviret/Mavyret, AbbVie) — 8 weeks for treatment-naive non-cirrhotic. These combinations achieve >95% SVR12 across genotypes, liver disease stages and HIV coinfection.

NS5A, NS5B, NS3/4A inhibitors
ResearchThe three main DAA target classes: NS3/4A protease inhibitors (glecaprevir, grazoprevir, voxilaprevir — suppress viral polyprotein cleavage); NS5A inhibitors (velpatasvir, pibrentasvir, ledipasvir — inhibit viral RNA replication complex); NS5B polymerase inhibitors (sofosbuvir — nucleotide analogue, high barrier to resistance). Combination of two or three classes achieves near-universal cure.

HCV genotypes 1-6
WHOHCV has six major genotypes with distinct geographic distributions: genotype 1 (Americas, Europe), genotype 2 (West Africa), genotype 3 (South Asia), genotype 4 (Middle East/North Africa), genotype 5 (South Africa), genotype 6 (Southeast Asia). Genotype 3 is associated with faster fibrosis progression and higher HCC risk. Pangenotypic regimens treat all without genotyping.

Treatment as prevention (TasP)
WHOSuccessfully treated HCV patients have undetectable HCV RNA and cannot transmit HCV. Population-level treatment of high-incidence groups (PWID, MSM) reduces HCV prevalence in those communities — treatment is prevention. Mathematical models show universal treatment could eliminate HCV in high-incidence populations within years.

Georgia HCV elimination programme
CDC/WHO/GeorgiaLaunched 2015 with CDC support and Gilead sofosbuvir donation — the world's first national HCV elimination programme in a lower-middle-income country. By 2023: >100,000 people treated; HCV viremic prevalence reduced from approximately 7.7% (2015) to approximately 5.4% (2022) and falling — a global model for elimination, cited by WHO.