Hepatitis C and Injection Drug Use

Circulation of Heart and Liver
Purestock / Getty Images

Hepatitis C (HCV) is a highly contagious virus that predominantly affects the liver. During the first 6 months after exposure, people are considered to have acute hepatitis C infection. Most people with acute infection, somewhere between 75 and 85 percent, will then go on to become chronically infected with the virus. The vast majority of new hepatitis C infections are spread by needle sticks. Needle-based hepatitis transmissions are generally either the result of needle sharing among people who use drugs, or accidents in health care settings.

Hepatitis C can also be spread by sharing household items that might be blood contaminated, such as toothbrushes and razors. It can spread through unprotected sex, although these transmissions are uncommon.

Left untreated, hepatitis C can potentially lead to cirrhosis, liver cancer, and other serious health complications. Historically, hepatitis C has been treated with pegylated interferon and ribavirin. These treatments are not 100 percent successful, and they can have significant side effects. The difficulty of getting treatment and those side effects make treatment adherence a real problem for hepatitis C patients. That further decreases the ability of PEG interferon and ribavirin to control the virus.

Fortunately, scientists have recently developed a new class of direct acting antivirals, or DAAs, to treat hepatitis C. These drugs are much more effective than the earlier treatments and they have fewer side effects.

However, they may not be available to all patients or in all areas of the country.

Did You Know: Hepatitis C is related to the hepatitis A (HAV) and hepatitis B (HBV) viruses. However, unlike hepatitis A and B, there is not currently a vaccine for hepatitis C.

Hepatitis C and Injection Drug Use

Injection drug use is currently the most common mode of transmission for hepatitis C.

According to the Centers for Disease Control, approximately one out of three active injection drug users under the age of 30 are infected with hepatitis C. In some states, that number could be substantially higher. In addition, the virus may be nearly ubiquitous among older populations of current and former injection drug users. The CDC cites an estimate that as many as 70-90 percent of those individuals are infected with hepatitis C. In part, these numbers are so high because they were exposed and infected before there was widespread awareness about the risks of needle sharing.

A number of infectious diseases can be transmitted by needle stick. Contaminated needles provide an easy route for bloodborne infections to move from one person to another. Even small amounts of blood and secretions can be infectious, which is why cleaning needles is not enough to eliminate risk. Where possible, needles should never be reused. Many cities and states have needle exchange programs that can provide injection drug users with sterile needles to reduce their risk of infection. These programs may also offer disease testing and drug counseling for people fighting injection. Evidence has clearly shown that needle exchange programs do not increase drug use.

They can, however, effectively reduce the spread of disease.

HIV & HCV Coinfection

Hepatitis C and HIV are two viruses about which there is a lot of concern in injection drug users. In fact, coinfection with both viruses is not uncommon in this population. Between 50 and 90 percent of HIV positive people who inject drugs are also infected with hepatitis C. This can make treatment decisions somewhat more complicated, although many specialists have lots of experience working with coinfected patients.

Changes in the public perception of HIV risk may have contributed to the increase in hepatitis C infections seen in the United States starting in the early 2000s.

As HIV transitioned from being seen as a death sentence to being seen as a chronic disease, people may have become less concerned about potential exposure to infected blood. Alternatively, they may believe that cleaning precautions that are reasonably effective against HIV are also effective against hepatitis C. Unfortunately, while HIV is a relatively fragile virus, hepatitis is not. Cleaning drug equipment or “works” in ways that can prevent HIV transmission is not similarly effective against hepatitis C.

How Injection Drug Use Affects the Course of Hepatitis C Infection

There is some evidence that Hepatitis C may behave differently in injection drug users than in people who acquire it sexually. People who inject drugs may have a harder time getting rid of these infections. They may also be more likely to reacquire infections after successful treatment. To date, the reasons for this are unclear. Some of the difference may be due to the particular types of hepatitis C to which people who inject drugs are exposed. It may be due to ongoing exposure among people who keep injecting drugs or who relapse after effective treatment. There also may be other factors involved that are not yet understood.

A Word From Verywell

If you’re infected with hepatitis C, it can be a difficult thing to talk about. Researchers have shown that many people don’t discuss their status with their partners. That includes both sexual partners and people with whom they are sharing needles. They may also not disclose their infection even to close family members.

For some people, it’s hard to talk about hepatitis C because of its association with injection drug use. Particularly if you are no longer using drugs, it can be scary to bring up that part of your past. For other people, it simply may not occur to them to talk about hepatitis C. They may have been infected for a long time without having any symptoms. They also many not know how the virus can be transmitted or if family members are at risk.

In general, hepatitis C can’t be spread through casual contact. However, it’s not only spread through needle sharing. It can also be spread through unprotected sex and the use of blood contaminated objects. Therefore, if you are sharing a house with someone, it’s useful for them to know to be particularly careful about using your toothbrush or razor. That’s also true if you’re sharing fluids more directly—through sex or through needles. People can’t manage a risk if they don’t know that it’s there.


Abdul-Quader AS, Feelemyer J, Modi S, Stein ES, Briceno A, Semaan S, Horvath T, Kennedy GE, Des Jarlais DC. Effectiveness of structural-level needle/syringe programs to reduce HCV and HIV infection among people who inject drugs: a systematic review. AIDS Behav. 2013 Nov;17(9):2878-92. doi: 10.1007/s10461-013-0593-y.

Hofmeister MG, Havens JR, Young AM. Silence Surrounding Hepatitis C Status in Risk Relationships Among Rural People Who Use Drugs. J Prim Prev. 2017 Jul 21. doi: 10.1007/s10935-017-0483-6.

Seaberg EC, Witt MD, Jacobson LP, Detels R, Rinaldo CR, Young S, Phair JP, Thio CL. Differences in hepatitis C virus prevalence and clearance by mode of acquisition among men who have sex with men. J Viral Hepat. 2014 Oct;21(10):696-705. doi: 10.1111/jvh.12198.

Young J, Rossi C, Gill J, Walmsley S, Cooper C, Cox J, Martel-Laferriere V, Conway B, Pick N, Vachon ML, Klein MB; Canadian Co-infection Cohort Investigators. Risk Factors for Hepatitis C Virus Reinfection After Sustained Virologic Response in Patients Coinfected With HIV. Clin Infect Dis. 2017 May 1;64(9):1154-1162. doi: 10.1093/cid/cix126.