In the lush landscape of Alappuzha, 52-year-old schoolteacher KV Thomas led what he considered an exceptionally healthy life, sustained by daily morning walks and a traditional diet. It came as a profound shock when a routine blood test ahead of a minor elective surgery revealed active hepatitis C infection. Thomas had experienced no jaundice, no abdominal pain, and no debilitating illness—only a mild, intermittent tiredness that he had brushed off for years as the natural toll of aging.
Epidemiologists traced the probable origin of his infection back nearly three decades to an emergency blood transfusion he received following a monsoon road accident in 1989, years before sensitive screening became standard practice in blood banks. His story illustrates the insidious nature of a pathogen that quietly resides in millions of human hosts, gradually compromising liver function without sounding a single clinical alarm until severe organ damage has taken root.
Hepatitis C is a blood-borne viral infection caused by the hepatitis C virus (HCV). Medical experts frequently designate chronic Hepatitis C as a “silent pandemic” because the initial acute phase of infection is notoriously asymptomatic in up to 80% of cases. On the rare occasions when acute symptoms do manifest—typically two to twelve weeks after exposure—they remain deceptively mild and non-specific, ranging from low-grade fever and loss of appetite to subtle joint aches and generalised fatigue.
While roughly 15-30% of infected individuals manage to clear the virus spontaneously through a robust immune response during these first six months, the remaining vast majority transition into chronic infection. This stealthy progression affects paediatric populations as well. As Dr Vikas Satwik, senior paediatrician and neonatologist at Motherhood Hospitals, Hebbal, Bangalore, points out, “Hepatitis B and C frequently go undetected in children because they are usually asymptomatic for many years. As there is no vaccine for hepatitis C, screening for babies who have the risk of contracting it must be done.”
Over decades, continuous immune activity against HCV replaces functional liver tissue with fibrous scar tissue. Over time, this progressive scarring develops into cirrhosis, an irreversible condition in which normal hepatic architecture is disrupted, severely impairing blood flow through the portal vein system and crippling the liver’s critical metabolic, detoxifying, and protein-synthesising capabilities. The liver, possessing a remarkable capacity to compensate for damaged tissue, works silently under stress until up to 70% of its structural integrity is compromised. This hidden degradation explains why individuals often feel completely energetic and active while severe scarring silently accumulates within the organ.
Societal barriers, stigma, and fear often compound the medical challenges, preventing individuals from seeking timely testing or care. “Hepatitis B or C patients are often reluctant to get screened because they fear how society will perceive them. But if they get screened and are diagnosed, we have effective treatments that can cure or suppress the disease, and we can prevent it from progressing to liver cirrhosis or liver cancer,” said Dr Charles Panackel, senior consultant, hepatology at Aster Medcity, Kochi.
The treatment landscape has undergone a revolutionary shift away from older, low-efficacy regimens toward curative oral therapies known as direct-acting antivirals (DAAs). For decades, standard treatment relied on injectable pegylated interferon combined with ribavirin—a grueling regimen that lasted up to a year, caused severe flu-like side effects, and yielded cure rates barely reaching 50%.
“There has been quite a paradigm shift in the treatment of hepatitis C in the last decade, owing to the advent of direct acting antivirals. Conventional treatment involved interferon therapy that was lengthy and had a low success rate of 40-60%. Nowadays, most patients can receive once-a-day oral therapy for 8 to 12 weeks with high efficacy rates that exceed 95% regardless of age or severity of disease,” said Dr Akhil Deshmukh, consultant, hepatology and liver transplant at Aster Whitefield Hospital, Bengaluru.
Detailing the exact treatment timelines, Dr Panackel adds, “Hepatitis C is treated with DAAs. Patients without cirrhosis need only three months of treatment, taken as a tablet once every morning. If the patient has cirrhosis, treatment extends to six months. ”
Child-friendly formulations have brought this same life-saving cure to younger patients without the heavy side effects or growth risks. “The oral drugs only require a period of 8-12 weeks to effectively cure children as young as three years old from hepatitis C, and they do so without any harmful side effects,” Dr Satwik added.
Unlike hepatitis A and B, hepatitis C currently lacks a protective vaccine due to its rapid genetic mutation rate. Consequently, global efforts to eliminate the virus rely entirely on active screening, early detection, and prompt therapeutic intervention. For Thomas, access to direct-acting antivirals proved life-changing. A three-month course of daily oral DAAs cleared his viral load entirely within four weeks, achieving a complete virological cure (SVR12) and allowing his liver tissue to begin healing.
