Primary prevention

Clean needles/needle exchange for intravenous drug users have been shown to decrease the risk of hepatitis C virus (HCV) transmission.[59] Although sexual transmission of HCV is very inefficient, safe sex is a reasonable precaution in people with multiple partners and in HIV-positive people. Safe injection practices decrease the risk of transmission and should be encouraged. There is evidence for the efficacy of harm reduction measures including needle and syringe programs and opioid agonist therapy (either alone or in combination) in reducing HCV transmission.[60]​ Disposable medical and dental equipment should be used during medical and dental procedures. The risk of acquiring HCV from unsafe medical practices is very low in developed countries.

Secondary prevention

Hepatitis C is a notifiable disease in the US and some other countries.

Abstinence from alcohol (including interventions to help cessation of alcohol consumption), maintaining ideal body weight, avoiding hepatitis A or B (via vaccination), and avoiding HIV via safe sex are prudent. Alcohol, obesity, or viral co-infection(s) may accelerate progression of liver disease. Alcohol use has a significant impact on the progression of hepatitis C virus infections to cirrhosis; each alcoholic drink per day is associated with an increase in the risk of cirrhosis by 11%.[134][135]

Other preventive measures

  • All patients with hepatitis C and no evidence of immunity to hepatitis A or B should be immunised with the respective vaccines. Vaccination against pneumococcal infection is recommended in all patients with cirrhosis.[66]

  • The risk of sexual transmission is extremely low (about 0.3% per year) for monogamous couples who are serodiscordant for the virus.[136] Therefore the US Centers for Disease Control and Prevention (CDC) does not specifically recommend safe sex under these circumstances.[137] Monogamous hepatitis C virus (HCV)-positive people are advised to discuss with their partners the low risk of viral transmission. However, persons with multiple partners or those at risk for sexually transmitted disease have a 0.4% to 1.8% per year transmission rate.[136] A particularly high-risk group for sexual transmission of HCV is HIV-infected men who have sex with other HIV-infected men.[138]

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