Hepatitis C in Pakistan: Symptoms, Testing and a Treatment That Cures

Pakistan carries one of the heaviest hepatitis C burdens in the world, with millions of people infected, and a large share of them do not know it. The virus can sit quietly in the liver for decades. The encouraging part is that hepatitis C is now curable in the great majority of patients with a short course of tablets, which makes finding it early one of the most valuable things you can do for your health.

What is hepatitis C?

Hepatitis C is a viral infection that inflames the liver. In about a quarter of people the body clears the virus by itself within six months. In the rest it becomes a chronic infection, which over many years can scar the liver (cirrhosis) and raise the risk of liver failure and liver cancer. Hepatitis C is a different virus from hepatitis A and B, and there is no vaccine for it, but there is a cure.

Hepatitis C symptoms

This is the part that surprises most people: hepatitis C usually has no symptoms for years. When symptoms do appear, they are often vague:

• Persistent tiredness and weakness
• Loss of appetite, nausea or discomfort in the upper right abdomen
• Muscle and joint aches
• Dark urine and pale stools
• Yellowing of the skin and eyes (jaundice)

In advanced liver disease, swelling of the legs and abdomen, easy bruising, vomiting blood or confusion can occur. Waiting for symptoms means waiting for damage, so testing is the only reliable way to know.

How hepatitis C spreads

The virus spreads through infected blood. In Pakistan the most common routes are:

• Reused or unsterilised syringes and needles, including at some clinics and for drips and injections
• Unscreened blood transfusions
• Reused instruments in dental, surgical or minor procedures
• Barber shops that reuse razors or blades
• Shared razors, toothbrushes or nail clippers at home
• Tattooing, ear and nose piercing with unsterilised tools
• From an infected mother to her baby during birth, which is uncommon

Hepatitis C does not spread through food, water, coughing, hugging, shaking hands or sharing plates and cups. People with the virus can live safely with their families.

Who should be tested?

It is sensible to get tested once if you have ever had surgery, dental work, a blood transfusion or injections at a clinic you are unsure about, if a family member has hepatitis C, if you are a healthcare worker or a regular barber customer, or if your liver tests were ever abnormal. Pregnant women are also commonly screened.

Tests: how a diagnosis is made

1. Anti-HCV antibody test: a simple blood screening test. A positive result means you have been exposed.
2. HCV RNA (PCR) test: confirms whether the virus is active in your blood right now and how much there is.
3. Genotype test: identifies the strain, which helps the doctor choose treatment. Genotype 3 is the most common in Pakistan.
4. Liver tests, ultrasound or FibroScan: show how much, if any, liver damage there is.

Modern treatment: a cure in about 12 weeks

Older treatment relied on weekly interferon injections with tough side effects. Today, treatment uses direct-acting antiviral (DAA) tablets, usually sofosbuvir-based combinations, taken once a day for about 12 weeks, or longer in people with cirrhosis. More than 95 percent of patients are cured. Cure means the virus remains undetectable in the blood 12 weeks after the course ends.

A few important points:

• The choice of medicine and the duration depend on your genotype, liver condition and other medicines, so these tablets must be prescribed by a doctor after proper tests.
• Finish the entire course, even if you feel fine after a few weeks.
• Do not buy these medicines on the advice of a shopkeeper or a relative.
• Many government hepatitis programmes and hospitals offer testing and treatment free or at low cost, so ask your doctor or local health office.
• A cure does not protect you from catching hepatitis C again, so keep following safe-injection habits.

Looking after your liver

• Avoid alcohol completely
• Ask your doctor before taking any painkiller or herbal remedy, as some are hard on the liver
• Get the hepatitis A and hepatitis B vaccines if you have not had them
• Keep a healthy weight, since fatty liver adds to the damage
• Have regular check-ups, including an ultrasound, if you have cirrhosis

How to protect yourself and your family

• Insist on a new, sealed syringe for every injection, and avoid injections when oral medicine will do
• Use a fresh blade at the barber, or carry your own razor
• Never share razors, nail clippers or toothbrushes
• Choose dentists and clinics that sterilise their instruments
• Make sure donated blood has been screened

Key takeaways

• Hepatitis C often causes no symptoms, so a blood test is the only way to know.
• It spreads through blood, mainly unsafe injections and shared sharp instruments, not through everyday contact.
• A 12-week course of antiviral tablets, prescribed by a doctor, cures over 95 percent of patients.
• Treatment protects your liver from cirrhosis and cancer.

Related medicines on Medimart

Hepatitis C is treated with antiviral tablets chosen by your doctor after tests. The backbone of most regimens is:

• Sofosbuvir: a direct-acting antiviral, usually combined with another antiviral depending on your genotype

Prescription medicines are supplied only against a valid prescription. Please take them only as advised by your doctor.

See liver and hepatitis care products on Medimart with delivery across Pakistan. Prescription medicines are supplied only against a valid prescription.

This guide is for general information and does not replace advice from a doctor. If you think you may have been exposed, please get tested.