Hepatitis C

Hepatitis C infection is more persistent than Hepatitis A or B.

Spread of Hepatitis C

While less commonly spread via sexual means that hepatitis B, it is still considered as a sexually transmitted disease. The main modes of spread of hepatitis C is through contact with the blood of an infected person.

Hepatitis C is most commonly spread via infected needles and sharp objects compared to sexual transmission.

Update 25th July 2014 – Hepatitis C has been found to be very rarely spread via sexual contact except between 2 HIV +ve MSM

The Natural History of Hepatitis C infection

The symptoms of hepatitis C infection is similar to that of hepatitis A and B. Approximately 20% of individuals who become infected with HCV will clear the virus from their body within 6 months, though this does not mean they are immune from future infection with HCV.

The other 80% of people will develop chronic hepatitis C infection, during which the virus may cause mild symptoms or no symptoms at all. These people will however carry the hepatitis C virus for the rest of their lives and will remain infectious to others. Like chronic Hepatitis B infection, chronic infection with hepatitis C virus may lead to cirrhosis and liver cancer in the long run.

Currently, there is no vaccine as yet for Hepatitis C. However, being vaccinated for Hepatitis B provides some protection against Hepatitis C.

Screening for Hepatitis C

Screening is usually done with a Hepatitis C antibody serology at 1 month post exposure.

This test unfortunately has a relatively high chance of a false positive result (about 1%). To confirm the diagnosis if the serology test if positive, we would proceed to do a Hepatitis C DNA test.

Hepatitis C and HIV

Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis stated  ‘Extended HIV follow-up (e.g., for 12 months) is recommended for HCP who become infected with HCV following exposure to a source coinfected with HIV and HCV.’

In other words for patients who got infected with Hep C and HIV at the same time, they need to be screened for HIV for up to 12 months. Not the usual 3 months window period.

Update March 2015

In recent published guidelines on HIV screening, it is no longer mentioned that a Hepatitis C and HIV co-infection can prolong the HIV testing window period. This could be due to the advent of better and more accurate tests.

Click here for more Info on HIV and Hep C Co-Infection Window Period
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About Dr. Tan
Dr. Tan graduated from the National University of Singapore in 2001. His residency was in the two largest public hospitals in Singapore; Tan Tock Seng Hospital and Singapore General Hospital.

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116 Comments

  1. Hai Dr Tan, I Recently Did unprotected anal Sex,after that i did an HCV test on the 13 week of my post exposure and the result is Negative. Can i consider this to be conclusive?

  2. hai doctors i have undergoes 3 test and my exposure is on 13 June 2016
    (i) Hepatitis C Antibody Test at of 3month 10days (Non Reactive)
    (ii) Hepatitis B Antigen Test at 2month 2 days (Non Reactive)
    (iii) HIV I & II Ag/Ab Test at 3month 10 days (Non Reactive)

    Ques: Is all my my test conclusive?

    • In my opinion they are but please verify this with the doctor who did your tests for you.

  3. Wisdom Seeker

    hai Dr Tan. I recently had an unprotected anal sex (NO BLOOD). AM I at high risk group of getting HCV? When is the appropriate duration for me to undergo the HCV test? i alrdy did an 4th generation hiv ag/ab combo test 7week of my post exposure.

    • Wisdom Seeker

      my HIV result is NON-REACTIVE

    • No you are not. The risk of getting HCV from anal sex is rather low. The accuracy of HCV screening really depends on what type of test you do. The window period for viral load tests is shorter than serology test. You should see a doctor to get advice for this. We cannot give such medical advice over the internet.

  4. Dear Dr Tan, Does Hcv trasmit via fingering? I have 3 months hiv test negative after my fingering episode.
    Request your views.
    Regards

  5. At 120 days (4 months) i did a Hep C antibody test, and it is non reactive. It is 100% conclusive ? or do i need another test at 6 months ?

    • In my view it is however this site is not meant to dispense medical advice. Please verify this with the doctor who did the test for you.

  6. I did 17 weeks of Hep C antibody test, it is 100% conclusive ? or do i need another test at 6 months ?

  7. Hi!
    Is hcv anti body test (negative) after 5week good as conclusive? Will it turn positive in 3month?
    Is sexual exposure consider low risk for hcv ?

    • It is very accurate however the HCV antibody test can take up to 16 weeks to become positive in some people. Sexual exposure has an extremely low risk of HCV infection.

      • thanks you doctor!..in your opinion shud i do anothet test to confirm because the risk is very low and i have financial problems

        • I cannot give you medical advice of the internet. You have to consult a doctor for this.

          • thanks you for the reply doctor..i am planing to consult a doctor and do a hcv pcr rna but now i dont have enough money yet i hav to wait for another month..it will be really great if i can have a advice from you doctor..is it really need to do hcv test after sexual exposure? I am going crazy 🙁

          • The risk of contracting HCV from sexual exposure is extremely remote. That is all I can say. I cannot tell you to test or not because that amounts to medical advice which we cannot give over the internet.

  8. Dear Doctor(s)

    On 12th November 2015, i have had a blood test on both HIV (HIV 1 and 2 Ag/AB) and Hep C (antibody test). Results came back “Not Detected” for each of the two tests. 3 weeks later (4th Dec), had a HIV rapid finger prick test and it was negative

    My last sexual exposure was on 2nd September 2015 whereby i was receiving (unprotected) oral sex from a female partner ONLY.

    Given my recent results on HIV and Hep C, do I need to repeat testing at 15th/16th weeks post-exposure from 2nd september 2015? This is under the notion that Hep C needs up to 15 or 16 weeks for conclusive results as well as the myth that Hep C might affect the reliability of the HIV results.

    Thank you very much

    • btw. forgot to ask if isotretinoin (Roaccutane) medication would affect the reliability of the test results mentioned?

      • No it will not affect the Hepatitis C results.

        • Thanks for the reply Dr, based on your reply – will it affect the HIV tests?

          Last question: are the 10 weeks HIV/Hep C results is good enough after the single oral sex exposure?

    • It is extremely unlikely to catch Hep C from a sexual exposure. Honestly if I were you I’ll leave it be and stop testing.

  9. Andreia

    Dear doctor,

    Do you think that an anti-HCV non reactive result after 2 months of a potential exposure would be enough to exclude HCV infection?

    Thank you and congratulations on the service you provide.

  10. tension

    Hi doctor,i am vry worried since i knw tat hcv cn prolonging hiv window period。can i knw abt the window period of hcv? I hv done hiv test before and it was negative. I just scare tat I hv hcv tat can prolonging HIV window period.

    • Window period for Hepatitis C virus is 6 to 10 weeks.
      Acute hepatitis C infection can prolong HIV window period. This is why a prolonged duration of follow up (12 months) is recommended.

  11. Fabiane

    Hi Dr. Tan,

    I did an HIV and HCV antibody test a one month, 3 months and 7 months after exposure with a razor in a beauty treatment. All were non reactive,

    Can I rest assured that I don’t have HIV or HCV?
    I was diagnosed now with oral lichen planus, the reason why iam so concerned.

    Thank you

  12. Sir
    sorry for question but i have not recived your feedback till now. Please give your opinion because it is very important to me. I repeat my question

    whether hiv virus can live outside the body in normal condition for 15 minutes.
    If someone use electric shaver who is hiv + and his blood on this shaver and after 15 minutes i use it and it cut my skin . Can in this way hiv can be transmitted. Please please please give your valuable opinion.

    • Dr Justin Sim

      HIV can technically live outside the body for up to 5 days but this requires perfect environmental factors (moisture, temperature etc.) In all likelihood the virus will die very quickly outside the body. It is incredibly unlikely to be able to pass on HIV via shaving. Best thing is not to share shavers.

  13. Sir,
    Whether hiv virus can alive outside the human body for 15minutes.
    If anyone use electric shaver and if he is hiv + and his blood on electric shaver .after that i use it after 15 minutes of his use and electric shaver cut my skin . Can in this way hiv transmited to me.
    Please tell me.

  14. Sir,
    I have 2 question . Please give me answer !

    1) whether tlc count in blood is high during the hiv window period effect the window period. My tlc count is high lik.e 10100,16100 etc continously. Even the day of hiv testing it is 16000. I have tested after least exposure 140 days after exposure by rapid test of hiv .
    2) i had taken quinie 6 tablets after 95 days of exposure but but before the my hiv test which is done after 140 day of exposure.
    Please doctor tell me whether my test is conclusive. Please give your valuable opinion i am in lot of stress.

    • Dr Justin Sim

      A high TLC (white blood cell) count can indicate many things, most commonly is some sort of infection (bacterial or viral). It is not usually a sign of HIV as this count is usually lower. If you have been feeling unwell it is best to see your doctor to try and find out why you have this high tlc. The rapid tests you did would be conclusive at 140 days so unless you had a new exposure you do not have HIV.

      • Thank you very much for your valueable opinion. Please sir tell me whether quinine tablets could do any impact on window period/hiv test.
        I had no further exposure after that. So now i can consider my hiv test is conclusive.

  15. Sir,
    Whether shingles during window period of 3 month increase the window period.
    Whether shingles is rare deases for which long window period required as for organ tranplant , pep ,chimotherapy etc. require.
    I am not sexually active person and i only consider electric machine as exposure because after use it in saloon my skin is infected within 2 days of use and shingles after 5 days of use.
    As many side shows shingles in young pepldole is hiv symptom and i am 26 year old
    I do my testing of hiv of rapid test of blood after 4.5 month of this exposure and result is neg. Can i consider it conclusive. Please help me i am in lot of stress.

    • Shingles does not affect the HIV testing window period. Your HIV test at 4.5 months to me is conclusive.

      • Thank you very much !
        Now after your opinion i can consider my 4.5 month rapid test is conclusive. Thank you again.

  16. Hi dr tan. My question is regarding hep c architect antigen assay. If you had a weak immune system and couldn’t produce antibodies would the antigen test still find infection? I’ve had 2 negative antibody tests a year after exposure but all my lymph nodes are swollen and hard from previous infections they never went down I read this is where antibodies are produced. I also had a negative hcv rna test but it was done privately and after blood draw it was put in an envelope and posted it took 5 days to reach the lab I read that it should be refridgerated and stored properly which it obviously wasn’t. Then I went to uk gum clinic and had negative antigen test it was negative also. I’m awaiting a properly handled hcv rna by pcr from a reputable hospital I’m still worried is the antigen negative a good sign. My exposure was kissing a female ex drug user and prostitute she bit my lip and broke the skin. She had a tounge piercing and bad teeth which could explain blood to blood contact

    • First of all you cannot catch HCV from kissing so I really don’t see a reason for you to be worried. Second of all I think the HCV RNA test is already conclusive despite the poor handling. Third, antibody production or the more specifically the lack of antibody production has not effect on antigen testing.

  17. Hi dr tan,

    I am a nurse in one of the hospital in singapore. During my annual screening, I am screened for HIV, hep b and c. My result came back and it turn out that it was reactive in anti hcv. I was so scared. I have no needle stick injury before or anything. But I do have contact with hep c patients with protective gears on. What are the chances it may be false positive??? The result for HIV and hep b is negative and non reactive. Please help…. I am so scared.

    • Dr Justin Sim

      The results do indicate that you have developed antibodies to the hep c virus. This may be an old infection or it could be current. What you need to do now is get another blood test done – a hepc RNA (PCR test). If this is positive then the infection is active. If it is negative then the infection is an old one and not currently active. Most Hep C cases become chronic but there are a few cases of the virus clearing on its own.

      It is known that sometimes there can be false postives. But by doing the RNA test we can get a better picture.

      • Thanks for replying Dr Sim. I just did the Hcv rna test. I am still waiting for the result. I am really scared. Sigh. I am still wondering how did I get expose to that??? Sigh….

  18. Dear Dr. Tan, US CDC stated that majority of population (97%) would detect HIV at 3 months post exposure and the remaining will take longer up to 6 months. However, BHIVA (British HIV Association) stated that 12 weeks is more than 99% accurate except for those with severely compromised immune system. I have been got the last combo test at 14 weeks hence I was quite relieved, just what concerned me is about the issue of HIV and HCV coinfection. According to your site, you stated that coinfection prolongs the window period for HIV, and i found some articles which mentioned 3 health workers seroconverted at 12 months after coinfection of HIV and HCV. However, according to another medical forum MedHelp, their STD specialist, Dr. H. Handsfield stated that coinfection would’nt affect window period of HIV as the body was able to multitask producing both antibodies the same time. Besides that, he also mentioned that the 3 health workers case was filed at early 90s which using the less sensitive 1st or 2nd gen ELISA hence they cannot perform as well as the 3rd gen and 4th gen ELISA. I am not trying to suspect your statements but as a biotechnology researcher I was also interested in knowing the truth. Just to satisfy my curiosity, Dr. yo are expert in this field, had you met any case of coinfection that result in prolonged HIV window period?

    Lastly, I had a question that hope you can clarify it for me,
    1) Is Hep C antibody test conclusive at 12 weeks post exposure ? Liver function test was done at the same time as well and everything went normal. I’m quite worry about this as the symptoms I’m having now is quite similar with it (itchy skin, abdominal pain and fatigue). If it was conclusive then I wouldnt concern about my HIV window period though.

    Millions of appreciation and have a nice day ahead.

    • Good question. I have in fact added an update to the article on HIV and Hep C co-infection. This whole issue was brought about by the guidelines on occupational post exposure published by the US CDC many years ago. In that guidelines, it recommended that health care workers co-infected with Hep C and HIV be tested for HIV up to 12 months post exposure. People then took that and extrapolated it to non-occupational (sexual) exposures which should not be the case in the first place. The guidelines on HIV PEP (occupational and non-occupational) and HIV lab diagnosis published by the US CDC, ASHM, BHIVA, European Guidelinea, Canadian guidelines, New York guidelines have all NOT mentioned Hep C and HIV co-infection at all. Notably, in these guidelines, the Combo test is now recommended as 1st line assay as opposed to the antibody test. So I completely agree with Dr Handsfield that the problem is not with a biologic response. The problem is with testing technology. So now that the new guidelines are recommending the Combo test, Hep C/HIV co-infection is not longer an issue. The Hep C antibody test is really as good as conclusive at 12 weeks. Some articles say 16 weeks but I think they are just being ultra-conservative.

  19. I am extermely scared. I just know that i had hep c after pregnancy. When should i screen my child for it?

    • You mean you have just delivered your child then was diagnosed with Hep C? I am so sorry to hear that. Hep C screening for newborns is complicated. You really need to see a specialist for it. Serology tests are usually not accurate for the first 6 to 12 months. RNA tests are more reliable.

  20. Hi doc, i am a hep c patient. Just known to me after my son was born last month. Will my son be infected from it? When is the best time to conduct a hep c on him to get the best accurate result?? Pls help.

  21. Dear Dr Tan, I am so impressed with the needed aid you are doing to humanity, thanks. Dr I had unprotected sex with my girlfriend on her period,she is hcv positive. The moment she told me she was hcv positive, it was already 4 weeks after sex with her on her period, I did the first test = cmia s/c ratio 0.2 negative and 1 did a second one after 3 months it was = cmia s/c ratio 0.1 negative. Am I free or I need another test ? Why is the s/c ratio fluctuations ? Is 0.1 higher and near positive than 0.2 ? Thanks dr.

    • The risk of contracting HCV from sexual intercourse is extremely low. Anyway the HCV serology test at 3 months is already conclusive. So you need not worry.

      • Thanks for your reply, I am better now. The reason for my worries is because there was blood everywhere because of her menstruation. Thanks and God bless you.

  22. Hi dr thank you for reply
    On this link page said it is 4-6 weeks for hcv pcr
    Link: http://www.drtanandpartners.com/hepatitis-c-affecting-the-hiv-window-period/
    On your forum you comment on my post ( I think maybe you miss understand my question)
    Link: http://www.askdrtan.com/forum/question/6547
    You said my hcv and hbv are not conclusive at 17 days.

    • Thank you for bringing this up. The post was written in 2011. I have not corrected it to reflect 2 to 3 weeks for the HCV RNA PCR.

      • Hello drtan.
        So after 3 week test consider conclusive.how about anti hcv test.when it could be conclusive.

  23. Hi doc
    It’s really confusing!! You said hcv pcr rna need 6 weeks, other website said 2-3 weeks, and the specialist in Other site justanswer said 3 weeks is conclusive. Which one is correct??

    • Did I say the HCV PCR RNA takes 6 weeks? I honestly do not remember saying that. I think it was either a really old comment or I was talking about the serology test and not the PCR RNA test. Please give me the link to that answer and I will update it. I agree that the HCV PCR RNA test is conclusive at between 2 to 3 weeks.

  24. Hi doc it is really confusing, on HCV RNA PCR!!!
    Ok, you said 6 weeks to be accurate, but other website said 2-3 weeks. Some also said 2 weeks is conclusive and some specialist in justanswer said 3 weeks is conclusive. Which one is correct??

  25. Is anti-HCV and Anti-HBV conclusive at week 10 using third generation M.E.I.A ?

    • Yes it is. The MEIA is usually used as a confirmatory test rather than a screening test. Usually the serology (IgG) is used as a screening test.

      • Thank You Doctor, I am not aware of IgG. Here are my results on the paper:

        – Anti-HCV Technique M.E.I.A AxSMY, S/Co = 0.06, Negative.

        – HBsAg, Technique M.E.I.A AxSMY, S/Co = 0.43, Negative. HBcAb, Negative – Week 10 HbsAb, Negative

        Can I confirm the conclusive of testing at week 10?

  26. candawlan

    test anti hcv E.C.L.I.A AT 89th of expose it is conclusive or not?

  27. Hi Dr Tan,

    What is the cost of Hep C RNA test at your clinic?

    Thanks.

  28. Hi Doctor,
    Thank you for spending time answering question here. I went to barber shop and the person who cut my hair accidentally cut my skin with the razor. Not sure if the razor were used by someone else before me. Now i read in the web that there is a risk of exposure to HCV from razor. Should i be worry?

    Thank You,

    • Well yes there is a theoretical risk of catching HCV or Hep B from a contaminated razor or other sharp objects. The problem is symptoms can be very vague. You should seek more advice from your doctor.

  29. Hi dr I want to know hcv antibody test aftet 16 weeks to a sexual exposure is conclusive ?

  30. Hi dr the assay was used to measured viral load of HCV after 46 days of sexual exposure is it conclusive test as its negative or do I need again please guide many thanks

  31. Hi dr I also did antibody HCV test at 58 days negative , RNA PCR HCV at 46 days resultd negative does it conclusive ? or still need further testing and when . Thankz for ur help & comments dr tan
    Does antibody test is conclusive at 10 weeks please

  32. thanks for reply so after 3 or 6 month do i need to repeat hcv rna pcr or antibody or dont need to thanks

  33. hi dr its really hard to reach you as due to ur busy routeen anyway i want to know after 46 days to risky sexual exposure how much hcv rna pcr is conclusive , how much this can be conclusive . does further test need after negative hcv pcr thanks

    • I think the Hep C RNA PCR is as good as conclusive at 46 days post exposure.

  34. Worry M

    Hello Dr Tan. 1 week ago, my thumb had skin contact with blood with Hep B and Hep C positive. Am I at risk? I am so worried!

  35. Hi Dr Tan, if I would like to do a normal hep C test, when will be the best time to do?

  36. If someone who has Hepatitis of any kind was bleeding ( a small cut on his hand ), and his blood did get onto the tip of the pen which was stabbed on me (by accident), can this transmit Hepatitis? Although the amount of blood is probably non-existent or very small and the pen was washed with water, hand sanitizer and soap together before it stabbed me?

  37. Hi Dr Tan,

    The result back back & both tests is a negative!! Thank you try much for ur encouragement during the past weeks… Is has been quite a depressing days for us!

    It’s really does suddenly made us has a sudden awareness of hepC disease though 🙂

  38. Hi Dr,
    I was having the result of hcv reactive and then with hep a & b negative.
    I do not understand where on earth might I have the exposure to. I did not do drug nor any blood transfusion before, nor into any mutliple sexual partner! But do have hospitalization for d&c before.
    What r the chances that the 1st blood test is false positive? Or how is the health care precaution in our hospital?

    I am being refer to a Gastro but was afraid of the result & the wait is going to be torturing.

    • Hi Abc,

      I have personally seen quite a fair number of false positive HCV results. There is a whole algorithm to HCV diagnosis which says that every positive serology has to be confirmed with RIBA and PCR. From your history, I can see that your risk of contracting HCV is very low. Our hospitals have the absolute highest hygiene standards, There is literally no way you could have caught HCV there. There is a good chance you are false positive. Stay hopeful and stay strong.

      rgds

      Dr Tan

      • Hi Dr Tan,

        I was given a RIBA & RNA test, but the waiting is very long 🙁
        Is there any possibility that the food we eat before the initiate screening blood test has an affect on the result? Was kinda thinking y was it being detected as anti-HVC reactive in the 1st place then?

        It is really encouraging to see your message… It given me something to look forward to!

        Thank you

        • Hi Abc,

          Nobody knows the reason behind false positive tests in HCV serology. It is also pointless to ponder over such possibilities. You have done the RIBA and RNA PCR which is the right thing to do. Now it is a waiting game. From your history, I am quietly confident that the RIBA and RNA PCR will exonerate you.

          rgds

          Dr Tan

  39. Thank you, Doctor!
    Okay will try to figure it out by tests ))

  40. Hello Doctor!
    I wanted to ask – i had the vaginal fluids of the CSW on my hands, and i scratched a small scratch on my head untill it started to bleed a little. Am i at risk of HCV or HBV if there was some vaginal fluids in my fresh scratch? For example if it were traces of menstrual blood (i am not sure if it was).

    • Hi reader,

      I can’t say that there are any medical studies to document that kind of risk. It sounds theoretically possible but I would say the risk if extremely miniscule. You know you can’t really say anything is impossible in medicine.

      rgds

      Dr Tan

      • sorry, wanted to ask, if i had two negative hiv duo at 4 weeks and 8 weeks, is it conclusive? would possible coinfection with hep b/c change the result?

        • Hi reader,

          If you have good reason to believe you are infected with Hep B or C then this discussion is outside the scope of this forum. Please consult with your doctor.

          rgds

          Dr Tan

  41. hi doctor,

    my last encounter was 1 year and 6 months before.
    At the 10th month of my post exposure. i did hiv1&2 and hcv test. my hcv test came positive.hcv rna range was less then 15. so doctor told me there is a chance to cure automatically. after 3 months ie.. by 13th month i got hcv negative.
    now 1 year and 6 months completed, i tested for hcv elisa and hiv elisa test both are negative. doctor told me hcv has been cured by my immune system.because last 4months i got hcv negative.
    also
    i tested for HIV1 RNA real time Quantitative test after 1 year and 6 months.
    My Result – Below Detection Limit.

    i was worried lot about hiv….

    1. there is any chance for hcv reinfection?
    2. will hcv affects my hiv test?
    3. are my HIV tests conclusive???
    4. there is any chances for late seroconversion?
    i really confused please help….

  42. worry ever

    dr tan for my 5 months hcv antibody test cames out negative can i move on?i start worrying 🙁

    • Hi worry ever,

      You do not have HCV. Please stop worrying.

      rgds

      Dr Tan

  43. Worry ever

    Dear dr tan I’m gay bottom here and I wanted to ask that can hcv transmited by sperm?cos my last exposure is 5 months back he cum in me and I tested for hcv 5 months after it cameos out negative but now I’m still so damn worrying and scared ??what can I do ?thanks doctor

    • Hi Worry ever,

      HCV can certainly be transmitted by unprotected receptive anal sex along with HIV and many other STDs eg rectal gonorrhea. You have already tested negative for HCV so why are you still worried? I would suggest that you see your doctor and discuss with him/her the need to screen for other STDs.

      rgds

      Dr Tan

      • Worry ever

        I did the hcv test 5 months after the exposure come out negative and I am still so worry and scared from your experience if I do another test on 6 months exposure the result will be any difference?Insomnia for few months can’t sleep I hope that the 5 months test can put this issue down

        • Hi Worry ever,

          I think you should speak to your doctor about seeking professional psychiatric advice.

          rgds

          Dr Tab

  44. Hi dr tan I had taken Hcv antibodies test after 55 days exposure and came out negative is it conclusive?

    • They are using Hcv eia test

    • Hi Ant,

      This is a tough one. To be technically correct, a HCV antibody test might take up to 6 months to become positive. A HCV RNA PCR will be accurate at 6 weeks. But the risk of HCV transmission via mucous membranes (i.e. high risk sexual exposure) is extremely low.

      rgds

      Dr Tan

      • worry and scare

        the exposure my friend’s blood touch my finger nails but my nails do not have any cuts or anything am i in risk?

        • Hi worry and scare,

          There is no risk of HCV from exposure to intact or non-intact skin.

          rgds

          Dr Tan

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