Hepatitis C


Hepatitis C is a slowly progressive and often silent disease of the liver caused by the hepatitis C virus (HCV). HCV was identified in 1989 and an antibody test to detect its current or past presence became available in 1991.

Less than 10% of people infected with HCV experience an acute symptomatic illness. Around 25 to 30% of those infected spontaneously clear their virus shortly after becoming infected. The remaining 70 to 75%, who fail to clear their virus, develop chronic infection and as a result are at risk of ultimately developing liver failure with the risk of also developing liver cancer. HCV chronically infected people generally remain asymptomatic for many years, although some report a variety of symptoms such as:

  • fatigue
  • muscle ache
  • weight loss
  • abdominal pain
  • nausea

Of those chronically infected, 5 to 15% are estimated to develop cirrhosis of the liver within 20 years of infection; factors associated with more rapid disease progression include:

  • heavy alcohol consumption
  • co-infection with HIV

There's currently no vaccine available to prevent HCV infection. However, treatment with direct acting antiviral (DAA) therapy leads to sustained viral clearance in over 90% of patients.

Further information on Hepatitis C can be found on the NHS Inform website.


NHS NSS guidelines

In response to a request from the National Sexual Health and Blood Borne Virus Advisory Committee of the Scottish Government, the development of the national guidance has been a collaboration between:

  • clinical leads in viral hepatitis in Scotland
  • National Services Scotland
  • Healthcare Improvement Scotland

View the National Clinical Guidelines for the treatment of HCV in adults

SIGN guidelines

Scottish Intercollegiate Guidelines Network (SIGN) published full guidelines on the management of hepatitis C infection in December 2013.

The SIGN management of hepatitis full guidelines and the quick reference guide can be found on the SIGN website.

Guidance for health clearance of healthcare workers (HCWs) and management of those infected with hepatitis B, hepatitis C and HIV

Guidance is available from Public Health England (PHE) for health clearance of healthcare workers (HCWs) and management of those infected with the following bloodborne viruses (BBVs):

  • hepatitis B
  • hepatitis C
  • human immunodeficiency virus (HIV)

View the guidance for health clearance for HCWs and management of those infected with HBV, HCV and HIV (external website).

Guidance on the investigation and management of occupational exposure to hepatitis C

Guidance on the risks and management of occupational exposure to hepatitis C was last issued in 1993 by the Public Health Laboratory Service (PHLS) Hepatitis Subcommittee. Since then, knowledge has increased about the:

  • prevalence of hepatitis C virus (HCV) infection in the UK
  • risks of occupational transmission
  • benefits of treatment

View guidance on the investigation and management of occupational exposure to hepatitis C

Guidance to support opt-out blood borne virus (BBV) testing in Scottish prisons

The Scottish Government updated the Sexual Health and Blood Borne Virus Framework in 2015. The update recommended the introduction of opt-out BBV testing in the Scottish Prison Establishment. A Short Life Working Group produced this guidance to support the delivery and  monitoring of opt-out BBV testing in Scotland’s prisons. The guideline has been developed in line with national guidelines and policies.

View the Guidance to Support Opt-Out BBV Testing in Scottish Prisons

For all infection prevention and control guidance visit the A-Z ​pathogens section of the National Infection and Prevention Control Manual.


Data and surveillance

Surveillance reports

Hepatitis C diagnoses database

Anonymised, epidemiological information from laboratory reports in Scotland since 1991, when HCV testing started, of everyone who's been diagnosed:

  • hepatitis C virus (HCV) antibody
  • Polymerase Chain Reaction (PCR)
  • antigen (Ag) positive

Hepatitis C test database

Sentinel surveillance of everyone tested for HCV in:

  • NHS Greater Glasgow & Clyde
  • NHS Lothian
  • NHS Tayside
  • NHS Grampian

Hepatitis C clinical database

Surveillance of patients who've attended one of the 18 liver clinics in Scotland for management of HCV infection. This includes patients who've been referred for assessment and those who've received treatment for their infection.

Sexual health and blood borne virus framework

The first Sexual Health and Blood Borne Virus Framework was published by the Scottish Government in 2011. For the first time the Framework brought together policy on:

  • sexual health and wellbeing
  • HIV
  • viral hepatitis

Five high-level outcomes were set out. Their aim was to strengthen and improve the way in which the NHS, the third sector and local authorities supported and worked with people at risk of STIs or BBVs. In 2015 the Framework was updated covering the period through to 2020.

The Sexual Health and Blood Borne Virus Framework outcomes were:

  1. Fewer newly acquired blood borne viruses and STIs; fewer unintended pregnancies.
  2. A reduction in the health inequalities gap in sexual health and BBVs.
  3. People affected by BBVs lead longer, healthier lives.
  4. Sexual relationships are free from coercion and harm.
  5. A society whereby the attitudes of individuals, the public, professionals and the media in Scotland towards sexual health and BBVs are positive, non-stigmatising and supportive.

Sexual health and blood borne virus (SHBBV) open access data portal

The Sexual Health and Blood Borne Virus (SHBBV) open access Data Portal contains a wealth of information together in a format which allows users to easily monitor Scotland’s progress nationally and locally against the Scottish Government’s SHBBV framework outcomes.