Hep C Relapse vs Reinfection
Last updated: March 2022
There is actually no clear definitions of each that are standard across all researchers and medical personnel. This can be very confusing for some, so it is recommended that anyone researching or discussing this be clear with those in the conversation about their own definitions. In this article I break down how hepatitis C relapse and reinfection can occur after treatment.
How do I know if my hepatitis C relapsed or if I am reinfected?
Your doctor can do blood tests to determine whether the strain of hepatitis C is the same or different from the one for which you were previously treated. Additional tests in other areas of your body (such as your liver) may also be done in order to check for internal symptoms and for the severity of them, if they exist. This may help determine whether the strain is the same, as well as how long your body has been fighting this strain of the virus. That may allow the doctor to understand whether to consider this a relapse or a new infection.
Was I ever really cured or can I relapse at any time?
When you begin treatment for hepatitis C, your doctor will regularly test your body in order to know whether the treatment protocol you are being given is working. When it does work, your doctor will make note of the successful stages. When you have had an undetectable viral load for one month of treatment, you will have a rapid virologic response. Three months into treatment, if you continue to have an undetectable viral load, you will be considered to have an early virologic response. For a doctor to tell you that you have been cured of hepatitis C, your viral load must be non-detectable for at least six months after you have completed treatment. This is called achieving a sustained virologic response and is the overall goal of any hepatitis C treatment.
Not all people who reach rapid virologic response will continue the same treatment to reaching early virologic response, and not all who reach that milestone will continue the same treatment to reaching sustained virologic response. This is why you must continue to see your doctor regularly through the treatment process so that your viral load can be monitored and any treatment needs can be addressed quickly.
When a person reaches the sustained virologic response level and is considered to be cured of hepatitis C, that means that the body is no longer showing signs of this specific strain of hepatitis C anymore and that the body can no longer transmit that strain to anyone else.
How do I know whether I am at risk of a relapse?
Most who relapse after being considered cured do so within two years of being cured. Many researchers believe that this is not an actual relapse in terms of hepatitis c (hep c) suddenly waking up or becoming active again but rather that some who are infected become infected with multiple strains of the hep C virus. Sometimes, the treatment that is given to the patient cures one strain of the virus (and thus causes it to no longer show up on blood tests or be visible via the patient’s symptoms) but not others. Over time, the other strain(s) of the virus become more active, and blood tests may be positive or symptoms may appear. In these cases, doctors will provide treatment for that strain of the virus as well as providing care for any symptoms.
How can I protect myself from hepatitis C relapse or reinfection?
For those worried about relapsing, talk with your doctor about being tested for hepatitis C on a regular basis after your original infection has been considered cured. This will allow your doctor to monitor your body for any additional strains of the virus and to provide reassurance or treatment as indicated by your test results.
Whether or not a person has ever had hepatitis C, the risk factors for becoming infected or reinfected are the same. To protect yourself, it is best to always practice safe sex, by using condoms/dental dams, by visiting only licensed tattoo parlors, by using only clean needles if you are engaging in IV drug use (or seeking help if you wish to stop using IV drugs), and by not coming in contact with blood that may be infected. As there are many strains of hepatitis C, you can become reinfected with the strain you previously had or with a new strain. Just as was true before your first infection, you may not see symptoms after becoming infected.
If you are concerned that you might be relapsing or that you might have become infected, talk with your doctor or visit a local clinic as soon as possible. A medical caregiver will be able to provide you with the information and/or testing that is right for you so that you can be aware of your hepatitis C status and receive the treatment or information that is right for you.1-6