Adults should get a one-time hepatitis C antibody test, followed by an RNA test if positive; after diagnosis, 8–12 weeks of oral medication can cure the vast majority

A blood sample is taken for hepatitis C antibody testing. The out-of-pocket cost is usually a few dozen yuan and varies by location. If positive, another blood test checks viral RNA to see whether the virus is still present. Those diagnosed can obtain treatment at a local designated hepatitis C hospital. Most regimens involve 1 tablet daily for 8–12 weeks, with medication costs reimbursed through China's medical insurance system. The hard part is remembering to get tested when you have no symptoms.

Hepatitis C spreads through blood, and there is no vaccine. The World Health Organization says chronic hepatitis C often remains symptom-free for decades; by the time symptoms appear, substantial liver damage may have occurred. A positive antibody test only shows previous infection; an RNA test is needed to establish whether the virus remains. About 30% of infected people clear the virus without treatment within 6 months. The WHO says 8–12 weeks of oral direct-acting antivirals can cure almost all patients. An evidence review for the US Preventive Services Task Force pooled 49 treatment studies and found cure rates above 95% across genotypes. Cure means no detectable virus in the blood 12 weeks after treatment ends. Serious adverse events occurred in 1.9%, and 0.4% stopped treatment because of side effects. The same review pooled observational follow-up studies rather than randomized controlled comparisons. Compared with people who were not cured, those cured had about 60% lower all-cause mortality (HR 0.40, 95% CI 0.28–0.56; 13 studies) and about 71% lower liver cancer risk (HR 0.29, 95% CI 0.23–0.38; 20 studies). A French study followed 9895 people with chronic hepatitis C for a median of 33.4 months. After adjustment for age, liver fibrosis, alcohol use, and other factors, treated people had about 52% lower all-cause mortality (HR 0.48, 95% CI 0.33–0.70) and about 34% lower liver cancer risk (HR 0.66, 95% CI 0.46–0.93). Among US veterans, 15059 people with hepatitis C and advanced liver disease received these drugs. Over an average follow-up of about 1.6 years, there were 2.6 deaths per 100 person-years among those cured, versus 12.3 among those not cured. After adjustment for other factors, mortality risk was about 74% lower (HR 0.26, 95% CI 0.22–0.31). In 2020, the US Preventive Services Task Force recommended screening all adults aged 18–79, a Grade B recommendation. Most people need testing only once in their lifetime. China's 2022 prevention and treatment guideline recommends antibody screening for all adults, regular testing for people with ongoing high-risk exposure, and RNA testing for everyone with a positive antibody result. In a 2006 national survey, antibody prevalence among people aged 1–59 was 0.43%. Pooled studies estimated prevalence at 0.60% in the general population, 48.67% among people who use drugs, and 6.59% among people receiving hemodialysis. China's National Healthcare Security Administration says a course of hepatitis C treatment usually cost over 50000 yuan before price negotiations. The three hepatitis C drugs added to medical insurance through negotiations in 2019 had average price reductions exceeding 85%. (United States, France / China)

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；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；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；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；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）；World Health Organization (2026). Hepatitis C（事实清单，2026-07-28）. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c；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；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；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

Controversy: a 2017 Cochrane review accepted only randomized trials. Most of the 138 trials it found were short term and could not establish whether these drugs reduced deaths or liver disease. It regarded “cure” as the absence of detectable virus in blood, whose relationship with fewer deaths had not been established in randomized trials. The mortality and liver cancer figures above all come from observational follow-up. No study directly compared screening with no screening either. China's national action plan names people preparing for surgery, transfusion, endoscopy, or dialysis, and those with unexplained abnormal liver function tests, for testing. It also includes people with a history of injecting drugs, selling plasma, multiple sexual partners, or sex between men. People with HIV and the spouses and sexual partners of people with hepatitis C should also be tested. The plan also calls for encouraging people aged 40 and older to get tested. The guideline says most current patients received blood transfusions or sold plasma before 1993. Tattooing, ear piercing, and sharing razors or toothbrushes may also transmit infection. Hugging and sharing bowls, chopsticks, or cups generally do not. Antibodies remain positive after cure; RNA testing is needed to check for reinfection. Reinfection is possible, and people who continue sharing injecting equipment should have an RNA test at least once a year. If diagnosed during pregnancy, treatment is deferred until after delivery and breastfeeding has stopped; contraception is needed during treatment. People with cirrhosis still need regular liver cancer surveillance after cure. For injecting equipment, see Item 30 in this section (do not share injecting equipment). Hepatitis B requires a different set of markers; see Item 14 (get the five-marker hepatitis B panel). For HIV, see Item 31 (get an HIV test once). The guideline says hepatitis C combined with excessive drinking can progress to liver failure; see Section 2, Item 19 (drink less alcohol or none). The main beneficiary is you, with protection also extending to your spouse and sexual partners.