Viral hepatitis C, referred to as hepatitis C or hepatitis C, is a disease caused by hepatitis C virus (HCV) that is mainly transmitted through blood. Chronic HCV infection can lead to chronic inflammatory necrosis and fibrosis of the liver, and some patients can develop cirrhosis or even hepatocellular carcinoma (HCC), which is extremely dangerous to the health and life of patients. Because of the insidious symptoms of hepatitis C patients, the diagnosis rate and antiviral treatment rate of HCV infection in China are low, so there are more hidden sources of infection in the population. Hepatitis C infection is expanding globally, with 71 million people infected with hepatitis C worldwide in 2015 The World Health Organization’s Global Hepatitis Report 2017, released this year, shows that about 325 million people worldwide are infected with chronic hepatitis B virus or hepatitis C virus, of which 257 million are infected with hepatitis B virus and 71 million with hepatitis C. Viral hepatitis caused 1.34 million deaths in 2015, making it the seventh leading cause of death worldwide. Viral hepatitis caused 1.34 million deaths in 2015, the seventh leading cause of death worldwide. Figure 1 Comparison of the incidence of viral hepatitis (/100000) under different axes What is the prevalence trend of hepatitis C in China? A survey says that the overall carriage rate of hepatitis C in the population in China is 3.2%, which means that on average, at least 3 out of 100 people may have hepatitis C. This works out to 30-40 million people with hepatitis C, which is a huge group. Figure 2 Number of hepatitis C cases in China from 2012 to 2016 According to the statistics of the CDC of the National Health Planning Commission, the number of viral hepatitis cases in China was 1.22 million in 2016, among which, the number of hepatitis C cases was 200,000, second only to hepatitis B (with 940,000 cases). Hepatitis C is not a screening item in routine medical examinations because it has been ignored by the public for a long time. The incidence of hepatitis C showed a magnitude increase in 2013 and 2015, and the overall five-year incidence rate has increased. As China has only started to pay attention to hepatitis C in recent years, the level of awareness is too low compared to hepatitis B. This, combined with the fact that there is no effective vaccine to prevent hepatitis C, has led to a rising number of hepatitis C infections, making it one of the most serious public health problems in our society. The dangers of hepatitis C are, in a sense, more serious than those of hepatitis B. Once infected with hepatitis C, only about 20 percent of people can spontaneously clear the virus. If you have had a blood transfusion, used non-disposable syringes and surgical instruments that have not been strictly sterilized, had a history of unclean sex or intravenous drug use, or have had skin and mucous membrane injuries such as tattoos, eyebrow tattoos, or ear piercing, you are in a high-risk group for contracting the hepatitis C virus and it is recommended that you get tested for antibodies to the hepatitis C virus as soon as possible. Once the disease is detected, antiviral treatment should be administered in a timely manner. HCV, the “silent killer”, has a low screening rate, low consultation rate, low treatment rate and high chronicity Among all viral hepatitis, hepatitis C is the most neglected. Hepatitis C is generally less symptomatic, less easily detected, and more likely to be chronic, and is characterized by low screening rates, low consultation rates, and low treatment rates. According to the World Health Organization, the global diagnosis rate of HCV infection was 20% in 2015, and only 7% of people diagnosed with hepatitis C infection received effective treatment. Some data show that only 5% of the 10 million people infected with hepatitis C in China are aware of the infection, and less than 1% are treated. HCV infection is characterized by high chronicity, and according to published data, 55%-85% of HCV-infected patients will develop chronicity, and the incidence of cirrhosis is 5%-15% and liver cancer is 2%-4% after 20 years; the death rate of liver cancer in the first year after diagnosis is about 33%. It can be seen that if hepatitis C virus infection is not diagnosed and treated in time, it will bring more health hazards and medical burden to patients. The progression from hepatitis B infection to cirrhosis is a relatively long process, usually taking 30-40 years. Hepatitis C, on the other hand, develops rapidly, often in as little as 10 years from infection to cirrhosis, and once cirrhosis occurs, 1-7% of patients will develop fatal liver cancer each year. Unlike hepatitis B, there is no effective vaccine to prevent hepatitis C, but it can be cured by antiviral drug treatment. Therefore, it is important to raise public awareness of hepatitis C and enhance the accessibility of hepatitis C testing and treatment services to achieve early detection and treatment to control the development of hepatitis C in China. With proper treatment, more than 95% of hepatitis C can be cured. Compared to hepatitis B, hepatitis C is much more treatable. After diagnosis, the cure rate for hepatitis C can be more than 95% through the best internationally recognized protocols for hepatitis C treatment. DAAs have been adopted internationally as the first-line drug for the treatment of hepatitis C and the traditional PR regimen is no longer recommended. The launch of Bristol-Myers Squibb’s Bristol-Myers (daltegravir hydrochloride tablets) and Sovalip (acrivir softgels) marks a new phase in the treatment of hepatitis C with direct antivirals (DAAs) in China. The timing of treatment for hepatitis C is different from that for hepatitis B. The hepatitis B virus is a DNA virus, while the hepatitis C virus is an RNA virus. The two viruses have different replication processes and, therefore, the timing of treatment is very different between the two. When treating hepatitis B, medication is recommended only if the DNA virus count is high and there is an elevated transaminase, otherwise, regular observation is sufficient. Hepatitis C is different; even if the transaminases are not high and the liver function is normal, as soon as the RNA virus is detected in the patient’s body, treatment should be promptly administered. Treatment options for DAAs Table 3 List of preferred regimens in the 2016 WHO updated guidelines for hepatitis C DAAs clear HCV by directly inhibiting HCV protease, RNA polymerase, or other sites of the virus to reduce or clear liver damage and stop progression to cirrhosis, decompensation, and liver cancer. Its safety is much higher than the traditional PR program, and the treatment indications are expanded, the treatment course is significantly shortened and the cure rate is greatly improved. Daily liver protection should not be neglected We remind you that when you do a physical examination, in addition to checking hepatitis B, you should also check for hepatitis C. Learn more about hepatitis C, pay attention to the transmission channels of hepatitis C, maintain good lifestyle habits, and always go to a specialist hospital to receive treatment when you find similar symptoms.