Hepatitis C is curable. As long as we aren’t reexposed to the virus, most of us will never need to worry about being infected again. However, occasionally we hear about hepatitis C virus reactivation in people receiving cancer treatment. I frequently receive questions about this. This is very confusing, because if you are cured, how is it that hep C can be reactivated?

Actually, the answer is quite simple. Hepatitis C reactivation DOES NOT mean reactivation once you are cured. It means a flare up in the liver of people who already have hep C. Here is an explanation of hepatitis C reactivation from the World Journal of Gastroenterology (June 2014),

Most chronic hepatitis C patients have stable HCV RNA levels over a long time period, which may be altered no more than 0.5 logs. In this context, hepatitis C reactivation can be defined as an increase of HCV-RNA viral load greater than 1 log10 IU/mL and/or at least a threefold increase in serum ALT in HCV infected patients.” - Hepatitis C virus reactivation in cancer patients in the era of targeted therapies, by Ozan Yazici, et al.

The study tells us quite clearly that participants have chronic hepatitis C. The purpose of the research is to observe if their hep C worsens. We call this a flare of hepatitis (or hepatic flare). People live with stable hep C for years and decades, then undergo cancer treatment, and they may experience a flare.

Ditto in the latest research published in the January 2018 issue of Hepatology. Harrys A. Torres and colleagues conducted a large prospective observational study to determine the incidence, predictors, and clinical significance of hepatitis C reactivation in patients receiving cancer treatment. (Title: Hepatitis C virus reactivation in patients receiving cancer treatment)

This study took place at MD Anderson Cancer Center from 2012 through 2016. Participants had all sorts of cancer, but those with liver cancer were excluded in order to be able to monitor liver lab tests more easily. More importantly, people with undetectable HCV RNA were also excluded.

The findings? Hepatitis C reactivation occurred in 23 percent of hep C-positive people who were treated for cancer. receiving cancer treatment, and most had an unremarkable clinical course. They concluded that, “HCV infection should not contraindicate cancer therapy and infected patients should have access to multiple cancer treatments with close monitoring while receiving regimens associated with HCV reactivation.”

So if your hep C was cured, rest easy; it isn’t coming back.