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Hepatitis C: Silent Infection to Curable Disease



Hepatitis C: Silent Infection to Curable Disease

Hawra Al Lawati, MD
Consultant, Infectious Diseases
Sultan Qaboos University Hospital, University Medical City

 

World Hepatitis Day, celebrated annually on July 28, is an opportunity to reflect on hepatitis C: a once-mysterious bloodborne infection that can silently damage the liver for decades, but is now curable in most people who are diagnosed.

Hepatitis C virus, or HCV, is a bloodborne virus that primarily affects the liver. It spreads through blood-to-blood contact, most often through unsafe injections, unscreened blood products, or needle-sharing. WHO estimates that 50 million people worldwide are living with chronic hepatitis C, with about 1 million new infections and 242,000 deaths each year, mostly from cirrhosis and liver cancer. While about 30% of people clear the infection on their own, most develop chronic infection, which can silently progress to cirrhosis over decades.

A Disease Without a Name
For years, clinicians could recognize hepatitis C by its consequences before they knew its cause. Patients, particularly those who had received blood transfusions, developed hepatitis despite testing negative for hepatitis A and B. The condition became known as “non-A, non-B hepatitis” a name that reflected the mystery surrounding it. In 1989, Michael Houghton’s team identified the virus and gave it a name: hepatitis C virus. Harvey Alter and Charles Rice later confirmed its clinical importance and proved that it caused the disease. Together, their work earned the 2020 Nobel Prize.

The Cure: Medicine's Quiet Triumph
For years, hepatitis C treatment was a test of endurance. Interferon-based therapy meant months of injections, difficult side effects, and cure rates that often remained below 50%. The arrival of all-oral direct-acting antivirals in 2013 and 2014 changed that completely. Today, most patients can be cured with 8 to 12 weeks of tablets, with cure rates above 95%, including many with compensated cirrhosis. Importantly, many current regimens are pan-genotypic, meaning a single treatment works across all major viral variants without the need for prior genotype testing. In roughly one generation, hepatitis C moved from a chronic infection that often had to be managed for life to one that can usually be cured in two months.

Successful treatment prevents progression to liver failure, reduces the risk of liver cancer, and removes a source of onward transmission. In that sense, cure is also prevention: every person treated means fewer opportunities for the virus to spread.

Lessons from the Region: Egypt and the GCC

Egypt shows what is possible when cure is treated as a public health strategy. Once home to one of the world's highest HCV prevalence rates, Egypt built a program around mass screening, simplified treatment pathways, and broad access to direct-acting antivirals. Over the course of a decade, prevalence fell from around 10% to 0.38%, more than 4 million people were treated, and in 2023 the country earned WHO's first “gold tier” validation on the path to hepatitis C elimination.

Qatar also launched an HCV elimination plan in December 2014, built on four pillars: primary prevention, early detection, clinical management, and continuous monitoring. The plan prioritized both screening and treatment, with all direct-acting antivirals provided free of charge to residents regardless of nationality. Early screening campaigns estimated viremic prevalence at around 2% in the general population; a follow-up campaign in 2016 showed this had already fallen to 0.82%. Together, these examples illustrate what coordinated public health action can achieve.

Path to Elimination

What began as a disease without a name is now a disease with a cure, a test, and a WHO target for elimination by 2030. The medicines exist, but the remaining challenge is implementation and finding those undiagnosed. If testing becomes routine, treatment becomes accessible, and cure is treated as prevention, hepatitis C can move from a silent epidemic to a preventable chapter in public health history.

References

  • World Health Organization. Hepatitis C. Fact sheet. Updated 2025. Accessed June 2026. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c
  • Choo QL, Kuo G, Weiner AJ, Overby LR, Bradley DW, Houghton M. Isolation of a cDNA clone derived from a blood-borne non-A, non-B viral hepatitis genome. Science. 1989;244(4902):359–362.
  • World Health Organization Regional Office for the Eastern Mediterranean. Egypt becomes the first country to achieve WHO validation the-first-country-to-achieve-who-validation-on-the-path-to-elimination-of-hepatitis-c.html on the path to elimination of hepatitis C. Cairo: WHO EMRO; 2023. https://www.emro.who.int/media/news/egypt-becomes-
  • Al-Romaihi HE, El-Khoury R, Himatt S, et al. Prevalence of hepatitis C virus infection in Qatar's resident population based on a national screening campaign. Scientific Reports. 2025. doi:10.1038/s41598-025-96722-z
  • Derbala M, Abd Farag E, Al-Romaihi H, et al. An overview of the hepatitis C control plan in Qatar. Eastern Mediterranean Health Journal. 2019;25(5). https://www.emro.who.int/emhj-volume-25-2019/volume-25-issue-5/an-overview-of-the-hepatitis-c-control-plan-in-qatar.html