Hepatitis C#

Hepatitis C is a viral infection caused by the hepatitis C virus (HCV). About 15-25% of people clear the virus on their own within 6 months (acute infection that resolves). The remaining 75-85% develop chronic infection, which can quietly damage the liver over years to decades.

Chronic HCV is silent in most patients. Symptoms - when they occur - often don't appear until significant liver damage has developed, which is why screening at-risk patients matters: detecting the infection before liver damage develops gives the best long-term outcome.

The two infections are commonly confused because of similar names and both affect the liver - but they're meaningfully different:

See Hepatitis B for the dedicated Hep B page.

Hep C is primarily a blood-to-blood infection. The most common routes:

• Shared injection drug equipment - the single most common transmission route in Canada today.
• Unsterilized tattoo or piercing equipment - particularly outside of regulated commercial parlours.
• Blood transfusions or blood products received in Canada before 1992 (when universal donor screening began) or in countries without modern donor screening.
• Healthcare procedures in settings without universal precautions - shared or improperly sterilized medical equipment.
• Needle-stick injuries in healthcare or first-responder settings.
• Shared personal hygiene items that may have trace blood (razors, toothbrushes).
• Intranasal drug use with shared straws or rolled bills.
• Vertical transmission (parent to baby at birth) - low risk, approximately 5%; higher if the parent is co-infected with HIV.

Sexual transmission is uncommon but can occur, especially in higher-risk contexts: multiple partners, concurrent STIs, HIV co-infection, or sex involving blood contact.

Hep C is not transmitted through casual contact - hugging, sharing food or drinks, kissing, coughing, or sneezing. Breastfeeding is generally safe unless nipples are cracked or bleeding.

Most people with Hep C have no symptoms until significant liver damage has developed - often decades after the initial infection. When symptoms occur:

Acute Hep C (within 6 months of infection - uncommon to notice):

• Fatigue, loss of appetite, nausea.
• Yellowing of the skin or eyes (jaundice) - in a minority of cases.
• Dark urine, pale stools.

Chronic Hep C (years to decades later):

• Persistent fatigue.
• Abdominal discomfort, often in the upper-right side.
• Joint and muscle pain.
• Easy bruising or bleeding.
• In advanced disease: jaundice, swelling in the legs or abdomen (ascites), confusion (hepatic encephalopathy).

Because chronic Hep C is usually silent, the absence of symptoms does not mean the absence of infection. Risk-based screening is the main way infections are caught early enough to prevent complications.

No. Unlike Hepatitis A and Hepatitis B, there is no licensed vaccine for Hepatitis C in clinical practice. Research has been ongoing for decades; the virus's genetic variability and ability to mutate has made vaccine development uniquely challenging.

The strategies for reducing Hep C are:

• Risk-based screening to detect existing infections early.
• Curative treatment to eliminate the virus in identified patients.
• Harm reduction for people who inject drugs (clean equipment, supervised consumption sites).
• Universal precautions in healthcare and tattoo/piercing settings.

Hep C is one of the most clinically rewarding infectious diseases to treat in modern medicine. A chronic infection that previously caused decades of liver damage can now be cured in 8-12 weeks with well-tolerated oral medication - cure rates exceed 95%.

The catch is that you have to know you have it. Most people with chronic Hep C feel completely well for years before liver disease develops. Risk-based screening identifies infections early so:

• Treatment can be offered before liver damage develops - the cure prevents cirrhosis and liver cancer.
• Transmission to others can be reduced - cured patients no longer transmit the virus.
• Population-level Hep C burden decreases - Canada has set elimination targets aligned with WHO goals to eliminate Hep C as a public health threat by 2030.

We add HCV testing to your requisition when one of these risk factors applies:

• Current or past injection drug use.
• Past incarceration.
• Born, lived, or travelled in an HCV-endemic country (sub-Saharan Africa, parts of Asia, the Middle East, Eastern Europe).
• Received healthcare in settings without universal precautions.
• Received blood transfusions, blood products, or an organ transplant before 1992 in Canada (when universal donor screening began).
• Hemodialysis patients.
• Needle-stick injuries.
• Tattoos or body piercings with non-sterile equipment.
• HIV co-infection or other STI-risk context.
• Intranasal or inhalation drug use with shared equipment.
• Sharing personal hygiene items or sharp instruments with an HCV-positive person.
• Homelessness or unstable housing.
• 3 or more sexual partners in the last 6 months (TeleTest policy - reflects higher background STI prevalence and the possibility of unrecognized blood-blood exposure).
• Adult-industry work (adult-film performance, sex work, or other professional contexts involving frequent sexual contact).

Mention any of these in your intake's medical-history section and the clinician will add HCV testing where appropriate.

The Canadian Task Force on Preventive Health Care does not recommend routine HCV screening for adults who are not at elevated risk.

The standard HCV antibody test detects antibodies your body has produced in response to the virus. Antibodies can take time to develop after exposure:

• Most people develop detectable antibodies within 2-12 weeks after exposure.
• Up to 6 months may be needed in some patients before the antibody response is reliably detected.

If your exposure was recent (within the last 6 months), the clinician may recommend a baseline test now + a repeat test at 3-6 months to confirm a negative result.

For known high-risk exposures (e.g., a needle-stick at work), some labs can also run HCV RNA (PCR) - which detects the virus directly and can turn positive earlier than the antibody test (within 1-3 weeks). This is usually ordered through occupational health or in-person specialist evaluation rather than through routine TeleTest screening.

The standard first-line test is an HCV antibody test through the provincial public-health laboratory. Possible results:

• Negative = no Hep C antibodies detected. No further testing needed in most cases.
• Positive antibody test = your body has been exposed to Hep C at some point. This does not by itself confirm active infection - some people clear the virus on their own but retain antibodies for life. A follow-up HCV RNA (viral load) test is needed to confirm whether you currently have an active infection.

If your antibody test is positive, the clinician will arrange the reflex HCV RNA test and refer you for further evaluation.

Modern Hepatitis C treatment uses direct-acting antiviral (DAA) medications - oral pills taken daily for 8-12 weeks. The treatment is well-tolerated and cures more than 95% of patients.

Compared to older interferon-based treatments (which were difficult to tolerate and had lower cure rates), the current DAA regimens are a dramatic improvement.

TeleTest does not directly manage Hep C treatment - if you test positive, you will be referred to an infectious disease specialist or hepatology clinic that manages HCV treatment in your province. The specialist will:

• Order confirmatory testing (HCV RNA, genotype, liver function tests).
• Assess for liver damage (sometimes including an ultrasound or FibroScan).
• Choose the right DAA regimen based on your specific situation.
• Monitor for cure (confirmed by an undetectable HCV RNA 12 weeks after treatment ends - called "sustained virologic response" or SVR).

Yes - in most provinces, Hepatitis C treatment is covered for eligible patients under provincial drug plans. Since the cost of DAA treatment is high (historically $50,000+ per course), provincial coverage has been critical to making cure accessible.

Coverage rules vary by province but most cover treatment for patients with confirmed chronic HCV infection. Your hepatology/ID specialist will coordinate the coverage application as part of arranging treatment.

• Treatment duration: 8-12 weeks of oral medication, depending on the regimen.
• Cure confirmation: an HCV RNA blood test 12 weeks after treatment ends - if undetectable, you are cured (sustained virologic response, or SVR).
• Total timeline from start to confirmed cure: approximately 5-6 months.

A positive Hep C antibody result triggers a follow-up message in your patient portal. The clinician will:

• Arrange the reflex HCV RNA (viral load) test to determine whether you have an active infection (positive antibody + positive RNA) or a past, resolved infection (positive antibody, negative RNA).
• If active infection is confirmed, refer you to an infectious disease specialist or hepatology clinic for confirmatory testing, liver assessment, and treatment.
• Discuss what the result means in your specific situation.

A positive antibody result by itself is not a death sentence - in many cases, it represents an old exposure that your body cleared. And even when active infection is confirmed, treatment cure rates exceed 95%.

TeleTest does not contact partners directly. Partner notification is your responsibility, but it matters less than for some other STIs because sexual transmission of Hep C is uncommon. Higher-priority notification scenarios:

• People you share or have shared injection equipment with.
• Anyone with whom you share personal hygiene items that may carry trace blood (razors, toothbrushes).
• Sexual partners, especially if there's been condomless exposure in higher-risk contexts (HIV co-infection, traumatic intercourse, multiple partners).

Public health may follow up - Hep C is a reportable infection in all Canadian provinces. The lab notifies public health of positive results; public health may contact you for counselling and partner-notification support. They reach out confidentially first.

• Hep C screening in pregnancy in Canada is currently risk-based, not universal (this is different from Hep B, which is universally screened in pregnancy). If you have any of the risk factors listed above, screening is recommended.
• If you test positive during pregnancy, your prenatal team will coordinate care with a specialist.
• Vertical transmission risk is low (approximately 5%); higher if you're also HIV-positive.
• Breastfeeding is generally safe with Hep C unless your nipples are cracked or bleeding.
• DAA treatment in pregnancy is not currently routine - the specialist will typically defer curative treatment until after delivery.

Yes. Hep C cure does not create lifelong immunity. If you are exposed again after cure (e.g., through ongoing injection drug use or other blood-blood exposure), you can be reinfected. Some patients have been treated and cured multiple times.

Harm-reduction strategies (sterile injection equipment, supervised consumption sites, partner-status awareness) remain important after cure if exposure risk continues.

Yes - Hep C antibody and confirmatory testing through the provincial public-health laboratory is covered by your provincial health plan when ordered by a clinician for an eligible resident. The lab fee is not billed to you.

TeleTest's consultation fee is paid out-of-pocket - this covers the asynchronous clinician review that authorizes the requisition. The blood test itself remains covered.

If you're not an eligible resident (no provincial health card or out-of-province), additional uninsured lab fees may apply.

Yes, in most provinces, for eligible patients with confirmed chronic infection. Direct-acting antiviral medication costs are high (historically over $50,000 per course), and provincial drug-coverage programs have been central to making cure accessible. Your hepatology/ID specialist will coordinate the coverage application as part of arranging treatment.