For many young adults, Hepatitis C feels like a disease from another era, or one associated only with extreme risk factors and older generations. It is rarely part of everyday health conversations. Unlike illnesses that announce themselves through visible symptoms, Hepatitis C often stays silent for years, quietly progressing in the background.
That silence is precisely what makes it dangerous. Medical experts warn that many people continue to think Hepatitis C affects only injection drug users or individuals with obvious medical vulnerabilities. In reality, exposure can happen in ways that feel surprisingly ordinary, through unregulated tattoo studios, improperly sterilised cosmetic procedures, shared grooming tools, unsafe injections, or healthcare exposures that may have happened years earlier.
Because symptoms may not appear until liver damage has already developed, awareness and early testing remain the most powerful tools. As the world observed Hepatitis Day on July 28, health experts explain why Hepatitis C deserves more attention from younger adults, the everyday exposures people overlook, and how modern treatment has transformed one of the world’s most feared liver infections into a disease that can now be cured in the vast majority of cases.
Why Hepatitis C can stay hidden for decades
One of the most misunderstood aspects of Hepatitis C is how quietly it behaves. According to Dr. Vibhor Borkar, director of paediatric hepatology, gastroenterology, and transplant medicine at Gleneagles Hospital in Parel in Mumbai, the virus often escapes attention because it replicates within liver cells without triggering a strong immediate immune response.
He explains, “Hepatitis C often remains undetected because the virus replicates quietly within liver cells without triggering a strong immune response, leading to chronic infection in nearly 80 per cent of cases.” The infection usually begins with an acute phase lasting up to six months. During this period, most people experience few symptoms or none at all.
Everything that follows is the more concerning stage: chronic infection. Persistent inflammation can continue for years and gradually lead to fibrosis, the process of scarring inside the liver. This damage accumulates slowly, often over two to three decades. Over time, fibrosis may progress to cirrhosis, where permanent structural damage limits liver function. In some patients, this eventually increases the risk of hepatocellular carcinoma, a form of liver cancer.
Dr Borkar notes that this progression may be particularly significant in India because genotype 3 remains the most common strain and is associated with faster disease progression and higher rates of liver-related complications.
The challenge is that early warning signs are often vague. People may experience mild fatigue, episodes of brain fog, or occasional abdominal discomfort and dismiss them as stress or poor sleep. Symptoms such as jaundice, swelling of the legs, or fluid accumulation in the abdomen often appear only after substantial liver damage has already occurred. India continues to carry a considerable Hepatitis C burden, with an estimated 5.5 million people living with chronic infection.
The myth that Hepatitis C only affects “high-risk” groups
One of the biggest barriers to prevention is perception. Dr. Deepak Kulkarni, consultant laparoscopic surgeon and coloproctologist at Apollo Clinic, says misconceptions continue to stop people from taking Hepatitis C seriously. He shares, “There are many people with the false idea that only the elderly or those with serious problems can get infected by the Hepatitis C virus.” That assumption can create a dangerous sense of immunity among younger adults.
Kulkarni stresses that age itself offers no protection, “A person may feel completely healthy and still carry the virus.” Another common misunderstanding is the belief that symptoms would automatically appear if infection were present. “That’s not true either; a lot of people go for years with Hepatitis C and aren’t sick at all.”
During those silent years, liver injury continues. Many people also remain unaware that treatment has changed dramatically. Some continue to assume Hepatitis C cannot be cured, a belief rooted in older treatment experiences rather than current medicine.
Dr Kulkarni says that outdated perception no longer reflects reality. The everyday exposures younger adults often overlook. When people think about Hepatitis C transmission, they often imagine only injection drug use or high-risk sexual behaviour. Experts say this narrow understanding misses many real-world situations.
According to Dr Borkar, Hepatitis C spreads strictly through blood-to-blood contact. It is not transmitted through food, water, hugging, coughing, or casual social interaction. But blood exposure can occur in unexpected ways.
Potential sources include reused razors at barber shops, where microscopic cuts may introduce infected blood. Unsafe injection practices continue to remain a concern in some settings. People who received blood transfusions before June 2001, prior to mandatory blood screening, may also carry risk.
Dental procedures performed with inadequate sterilisation deserve attention as well. Borkar highlights the growing popularity of tattoos and piercings among younger populations. Unregulated tattoo studios may appear hygienic while still failing critical sterilisation standards.
Sharing personal grooming items such as razors, toothbrushes, and nail clippers can also become problematic because microscopic traces of blood may remain unnoticed.
Even though sexual transmission is possible, Dr Borkar notes that it remains relatively uncommon and usually requires situations involving blood exposure.
Tattoos, cosmetic procedures and the hidden hygiene gap. Body art and cosmetic procedures have become increasingly mainstream, but experts caution that aesthetics should never come before safety. Borkar says concerns around unregulated tattoo studios, microblading services, and cosmetic procedures are legitimate.
When procedures are performed in regulated environments using disposable needles, autoclave sterilisation, and single-use materials, infection risk remains extremely low.
The problem begins when shortcuts are taken, even if equipment appears visually clean, Hepatitis C may survive outside the body for up to sixteen hours. That means inadequate sterilisation can still create transmission risk. The same concerns extend beyond tattooing. Permanent makeup procedures, manicures, pedicures, and cosmetic treatments involving skin penetration require proper hygiene standards.
Consumers should expect sealed needles to be opened in front of them. Facilities should use disposable supplies wherever possible and maintain visible sterilisation practices. Staff should wear fresh gloves. Dr Borkar advises avoiding any establishment that relies only on rinsing instruments or wiping them with alcohol.
Dr Kulkarni echoes this message. Before undergoing any tattoo, piercing, or cosmetic treatment, he recommends choosing licensed facilities, confirming that needles are new and single-use, and asking questions about infection control practices. Roadside stalls or informal providers should be avoided regardless of cost advantages.
Who should consider getting tested?
Experts increasingly argue that Hepatitis C testing should move beyond narrow definitions of risk. Borkar puts it bluntly, “The question today is no longer Who should get screened? but rather Who shouldn’t?”
Priority groups include:• People who received blood transfusions before 2001• Individuals with a history of injection drug use, even once• Patients receiving haemodialysis• People living with HIV or Hepatitis B• Healthcare workers exposed through needlestick injuries• Individuals with unexplained liver enzyme abnormalities• People with tattoos or cosmetic procedures performed in questionable settings• Individuals exposed to unsafe injection practices• Family members where blood-sharing exposures may occur
Dr Borkar also highlights adults over 40 years of age and those aged 35-44 as age groups that account for a large proportion of chronic infections.
Dr Kulkarni adds that people born to mothers with Hepatitis C and individuals who have had potential blood contact with infected individuals should also consider testing. Importantly, symptoms should not determine whether someone gets tested. “People without symptoms may still carry the virus. A simple blood test can identify infection before serious complications develop. The treatment revolution that changed everything. For decades, a Hepatitis C diagnosis created fear because treatment was difficult, prolonged, and unpredictable,” he says.
That landscape has changed dramatically. According to Borkar, the biggest breakthrough came with Direct-Acting Antivirals, commonly known as DAAs. Earlier treatment relied on Interferon and Ribavirin. Those therapies lasted up to forty-eight weeks and frequently caused severe fatigue, anaemia, depression, and flu-like symptoms.
For India’s predominant genotype 3 strain, cure rates remained only around 40 to 50 per cent. Since 2014, antiviral treatment has transformed outcomes. DAAs directly interrupt viral replication and make treatment shorter, simpler, and significantly more effective.
Today, treatment generally lasts only eight to twelve weeks. Side effects are usually mild and often limited to headaches or fatigue. Most importantly, cure rates now exceed 95 per cent. Borkar notes that India benefits from access to affordable generic medicines including sofosbuvir, velpatasvir, ledipasvir, and daclatasvir. Treatment costs have reduced substantially, and government programmes under the National Viral Hepatitis Control Programme provide medicines free of cost for eligible patients.
Indian studies have reported cure rates ranging from 91.2 to 98.1 per cent, matching outcomes seen internationally. For patients diagnosed today, Hepatitis C has become one of the most treatable viral diseases.
What to do if your test comes back positive
Receiving a positive result can feel overwhelming, but experts emphasise that panic is unnecessary. Dr Kulkarni says the first step is consultation with a liver specialist or gastroenterologist. “Additional blood tests and imaging may be needed to evaluate liver health before selecting treatment.
Most patients begin antiviral therapy that lasts between eight and twelve weeks. Success depends heavily on completing treatment as prescribed and attending follow-up appointments.”
Lifestyle choices also matter, according to experts. Patients are generally advised to avoid alcohol, prioritise nutrition, maintain physical activity where appropriate, and support overall liver health during treatment. The earlier treatment begins, the greater the opportunity to prevent long-term complications. Even patients who already have cirrhosis benefit because treatment reduces ongoing damage and lowers future cancer risk.
Feeling healthy does not always mean being healthy
Hepatitis C remains one of medicine’s quietest infections. People can live for years without symptoms while liver damage continues silently, which is exactly why awareness matters.
The goal is not fear. It is recognition that everyday decisions, where we get a tattoo, how carefully procedures are performed, whether we share grooming tools, and when we choose testing, influence long-term health.
Today, Hepatitis C is preventable, detectable, and in most cases curable, but cure begins with one thing that many people still postpone: getting tested. If there is uncertainty about past exposure, do not wait for symptoms. The liver rarely complains early. Listening before it does may make all the difference.
World Hepatitis Day 2026: Hidden Hepatitis C risks among young adults
