Important Ways to Avoid Hepatitis C Reinfection

In the 1990s and early 2000s, the only treatment for hepatitis C (HCV) was interferon — a drug that cured fewer than 10 percent of people who took it and often caused debilitating side effects. Since 2014, the U.S. Food and Drug Administration has approved several direct-acting antiviral (DAA) medications for hepatitis C. These new treatments cause far fewer side effects than the older ones and can cure the vast majority of people who take them.

“We can never promise a cure, but [DAAs are] about as close as anything in medicine to a guarantee,” says Nancy Reau, MD, the section chief of hepatology and a professor of transplant hepatology at Rush University Medical Center in Chicago.

While DAAs are a game changer for treatment, they can’t prevent you from being reinfected with hepatitis C. “That would be like telling a patient, ‘If I give you antibiotics … you can never get an ear infection again,’” says Dr. Reau. “[DAAs] are incredibly good at eliminating an active infection, but there’s nothing preventive about them.”

Here’s how you can be reinfected, plus ways to protect yourself against getting the virus again.

How Hepatitis C Medications Work

Hepatitis C is an infection that spreads through blood. In some cases, the body clears the virus on its own. Otherwise, the infection becomes chronic. Left untreated, chronic hepatitis C can lead to liver problems, including scarring of the liver ( cirrhosis), liver cancer, and liver failure.

Today, DAA oral medications cure both acute and chronic hepatitis C in nearly 100 percent of people who take them, with just 8 to 12 weeks of treatment, according to the Centers for Disease Control and Prevention (CDC).

“We would expect to be able to get rid of the virus in about 99.9 percent of people, even if it required more than one course,” says Reau.

Although these new antiviral drugs effectively treat an infection, they can’t prevent you from getting the virus again if you’re exposed. Once you’re cured of hepatitis C, your body develops antibodies, but they don’t act against the virus, says K. V. Narayanan Menon, MD, a hepatologist and the medical director of the liver transplant program at Medical City Transplant Institute in Dallas.

Who’s at Risk for Hepatitis C Reinfection?

A review published online in February 2023 in Clinical and Molecular Hepatology suggests that, among 100 low-risk people, the odds of being reinfected with hepatitis C were less than 1 percent per year. But, that rate may increase to about 6 percent among people who engage in high-risk behavior, such as injection drug use.

Risk factors for HCV reinfection include:

• Injecting or inhaling illegal drugs
• Getting a piercing or tattoo with equipment that’s not properly sterilized
• Having sex with multiple partners without using a condom, especially if you’re a man who has sex with men
• Being a healthcare worker who’s more likely to be exposed to infected blood
• Having HIV and engaging in high-risk behaviors (people with HIV who are exposed to hepatitis C have a higher chance of getting hepatitis than people without HIV who are exposed, says Reau)

Tips to Avoid Hepatitis C Reinfection

There is no vaccine for hepatitis C, but taking precautions can help protect you from being reinfected. “As long as you don’t go back to infective behaviors, you shouldn’t get reinfected,” says Dr. Menon. Here’s how you can help protect yourself.

• Never share needles, and get help to stop injecting drugs. Sharing dirty needles is one of the most common ways hepatitis C spreads, so use a clean one each time, until you can successfully quit. It’s often very hard to stop using drugs on your own, so ask a medical professional for a referral to a treatment program if you’re struggling.
• Take precautions for piercings and tattoos. Only go to a reputable shop, and ask employees how they sterilize their equipment. If they don’t answer your questions, or sterilize their equipment, go somewhere else.
• Practice safer sex. Always use protection if you have multiple partners or don’t know whether a partner is at risk for hepatitis C.
• Have your partner get tested. Although infections between monogamous couples are rare, they do happen. “The risk of transmission among couples is low, but if you have HCV, I think it’s important for your significant other to get tested, especially because we have such good treatments now,” says Menon.
• Get vaccinated against hepatitis A and B. Both of these viruses can also damage the liver, and people with hepatitis C can be more susceptible to the viruses’ effects.
• Steer clear of alcohol, and be cautious with medications and supplements. While these substances don’t put you at risk for reinfection, alcohol and certain prescription and over-the-counter medications, herbs, and supplements can further damage the liver. Be sure to talk to your doctor before popping any pill.

Finally, don’t skip hepatitis C treatments just because you’re still struggling with addiction: You deserve care, plus you could transmit the virus to others.

“If a clinician thinks that someone is actively using, they might have some intrinsic bias to think that they won’t be compliant with the medication or will just get reinfected,” says Reau. “But, someone who’s interested in treatment and still has reinfection risks is a very important person to prioritize.”

Resources for At-Risk People

Rising opioid use in the United States has led to an increased number of viral infections, including HCV and HIV. Opioids and methamphetamines are the most commonly injected illegal drugs, according to the American Academy of Family Physicians. “Most newly acquired hepatitis C [cases] in the younger generation [are] linked to the opioid epidemic,” says Reau.

People who try to quit opioids cold turkey are very likely to relapse, according to the National Institute on Drug Abuse. There are many resources that can help you quit using, though, and reduce your risk of hepatitis C and other infections. Here are a few.

• Medication-assisted treatment (MAT) In treatment programs, you may receive opioid agonists (such as methadone or buprenorphine), which reduce opioid withdrawal and cravings by acting on the same receptors in the brain that are activated by opioids. Opioid antagonists (such as naltrexone) block the brain’s opioid receptors so taking the drug doesn’t lead to the same euphoric effects that cause addiction. MAT doesn’t simply replace one drug for another. These medications have been proven to be very effective in treating drug addiction and sustaining recovery.
• Treatment clinics for opioid use disorder Many people benefit from a combination of behavioral treatment and medication. You can find a quality drug treatment center in your area using the Substance Abuse and Mental Health Services Administration’s (SAMHSA) behavioral health treatment services locator, buprenorphine practitioner locator, or opioid treatment program directory. Choose a program that makes you feel comfortable and welcome and is convenient for you. “Offering someone who is struggling with addiction the ability to control their addictions is often lifesaving,” says Reau.
• Needle exchange programs Syringe services programs (SSPs) are linked to a 50 percent reduction in HCV and HIV infections, according to the CDC. “Using clean needles is the best way to prevent infection,” says Menon. “If you share a needle with someone who’s already infected, that’s the way it’s transmitted.” See the North American Syringe Exchange Network (NASEN) site for a directory of programs by area. Doctors in 48 states (excluding Delaware and Kansas) and Washington, DC, are also allowed to prescribe or dispense syringes to people who inject drugs. Never share syringes, and always dispose of needles after a single use.
• Mental health and social work services If you’re struggling with finances, social workers can help connect you with employment and food programs, childcare, and healthcare. It’s also essential to seek therapy if you need it. “Underlying depression or uncontrolled anxiety are often where someone will relapse, because they’re using their addiction to treat another psychiatric complication,” says Reau. Most social workers and therapists offer their services online, she adds. And, there are many ways to access more affordable therapy, including finding a therapist who offers sliding fees, trying group therapy, or checking with your community health center or a nearby college.
• Free condom distribution If you have sex with multiple partners or aren’t sure of a new partner’s HCV status, condom distribution programs can help you access free condoms and information about safe sex. Many local health departments have condom distribution programs; search online to find one near you.

Know that if you have health insurance, federal law requires your insurer to pay for mental health and substance use treatment. See the SAMHSA website for more information about counseling and the U.S. Department of Health and Human Services site to learn about insurance coverage for mental health and substance use disorder services.