Hepatitis C Causes, Symptoms, Diagnosis, Treatment and FAQs

What is hepatitis C?

Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV) that primarily affects the liver. During the initial infection, people often have mild or no symptoms. Occasionally a fever, dark urine, abdominal pain, and yellow tinged skin occurs.

The virus persists in the liver in about 75% to 85% of those initially infected. Early on chronic infection typically has no symptoms. Over many years, however, it often leads to liver disease and occasionally cirrhosis. In some cases, those with cirrhosis will develop serious complications such as liver failure, liver cancer, or dilated blood vessels in the esophagus and stomach.

HCV is spread primarily by blood-to-blood contact associated with intravenous drug use, poorly sterilized medical equipment, needlestick injuries in healthcare, and transfusions. Using blood screening, the risk from a transfusion is less than one per two million. It may also be spread from an infected mother to her baby during birth. It is not spread by superficial contact. It is one of five known hepatitis viruses: A, B, C, D, and E. Diagnosis is by blood testing to look for either antibody to the virus or its RNA. Testing is recommended in all people who are at risk.

Is hepatitis C serious?

Hepatitis C can be serious and, without appropriate treatment and care, can cause liver disease and liver cancer leading to death.

What are the Symptoms of hepatitis C?

HCV often does not present symptoms at its acute stage. However, the condition can escalate to a chronic stage at which potentially fatal complications can develop.

Acute hepatitis C

Acute HCV infection is rarely diagnosed due to the lack of definitive symptoms. It is often referred to as a silent epidemic. The average time frame from exposure to noticeable symptoms is between 4 and 15 weeksTrusted Source.

During this acute period, symptoms will not seem different to those caused by any other viral syndrome. People with acute HCV will experience:

  • abdominal discomfort
  • nausea
  • fever
  • joint pain
  • fatigue
  • jaundice, rarely
  • clay-colored stools, rarely

Chronic hepatitis C

HCV becomes chronic when the virus remains in the blood for six months after the acute infection period. If the presence of HCV viruses is detected in testing at least twice over this period, a chronic diagnosis is confirmed.

The infection will not resolve unless treated with medication.

Most people experience no symptoms with chronic HCV infection. Some may experience ongoing episodes of abdominal pain, persistent fatigue, and aching joints.

After 25 to 30 years, this chronic infection may result in significant scarring, or fibrosis, of the liver. If the entire liver becomes scarred, this can progress to cirrhosis, liver failure, and possibly liver cancer.

The overall health of the infected individual and their liver will determine how quickly damage and possible progression to cirrhosis will occur. The genotype of the virus plays less of a role than the physical health of the person with HCV.

It is not until the liver is on the verge of collapse that the extent of HCV damage is apparent.

How hepatitis C is spread

Hepatitis C is spread by blood-to-blood contact through needle puncture, broken skin or a break in mucous membranes (the thin moist lining of many parts of the body such as the nose, mouth, throat and genitals).

In Australia, most infections are associated with sharing injecting equipment. This accounts for 90% of new cases of hepatitis C each year.

Other ways hepatitis C can spread are:

  • through non-sterile tattooing, body piercing and acupuncture
  • through non-sterile medical or dental procedures, particularly in countries where hepatitis C is more common
  • from mother to infant during delivery if the mother has high levels of hepatitis C virus in her blood
  • in occupational settings through needle stick injuries and accidental exposures to infected blood or blood products
  • through transfusion of infected blood or blood products in Australia before screening was introduced in 1990.

Is hepatitis C contagious?

Hepatitis C is contagious. However, because it’s only spread through blood-to-blood contact, it isn’t likely that you’d get hepatitis C through casual contact. There are many other infections that are a lot more contagious. However, it’s important to know how hepatitis C can and can’t spread.

Can hepatitis C infection affect other organs besides the liver?

Most of the signs and symptoms of hepatitis C infection relate to the liver. Less often, hepatitis C infection can affect organs other than the liver.

Hepatitis C infection can cause the body to produce abnormal antibodies called cryoglobulins. Cryoglobulins cause inflammation of arteries (vasculitis). This may damage the skin, joints, and kidneys. Patients with cryoglobulinemia (cryoglobulins in the blood) may have

  • joint pain,
  • arthritis,
  • a raised purple rash on the legs, and
  • generalized pain or swelling of their bodies.

In addition, infected individuals with cryoglobulinemia may develop Raynaud’s phenomenon in which the fingers and toes turn color (white, then purple, then red), and become painful at cold temperatures.

Who is at high risk and should be tested for hepatitis C infection?

The U.S. Preventive Health Services task force recommends that all adults born between 1945 and 1965 be tested once routinely for hepatitis C, regardless of whether risk factors for hepatitis C are present. One-time testing also is recommended for:

  • People who currently inject drugs or snort drugs, or ever did so, even once many years previously
  • People with persistently elevated alanine aminotransferase (ALT) level, a liver enzyme found in the blood
  • People who have HIV infection
  • Children born to HCV- or HIV-infected mothers
  • People who were ever on long-term hemodialysis
  • People who got a tattoo in an unregulated setting, such as prison or by an unlicensed person
  • People who received clotting factor produced before 1987
  • People who received transfusions or organ transplants before July 1992, or who were notified that they received blood from a donor who later tested positive for hepatitis C infection
  • Health care, emergency medical, and public safety workers after a needlestick, eye or mouth exposure to hepatitis C-infected blood

People who may have been exposed to hepatitis C in the previous 6 months should be tested for viral RNA load rather than anti-HCV antibody, because antibody may not be present for up to 12 weeks or longer after infection, although HCV RNA may be detectable in the blood as soon as 2-3 weeks after infection.

In general, yearly screening may be appropriate for people with ongoing risk factors such as repeated sexually transmitted diseases (STDs) or many sex partners, ongoing IV drug use, or long-term sex partners of people with hepatitis C. Whether or not to test these people is determined on a case-by-case decision.

There is a 4%-7% risk of transmitting HCV from mother to infant with each pregnancy. Currently, there is no CDC recommendation for routine hepatitis C screening during pregnancy, and there is no currently recommended medicine to prevent transmission from mother to infant (prophylaxis). However, CDC is monitoring research findings and may make recommendations in the future as evidence arises.

While data is still limited, a recent study of over 1,000 cases in the United Kingdom found that 11% of infants had been infected at birth and that these infants were likely to develop cirrhosis in their early 30s. The case for screening for HCV during pregnancy includes the potential to safely treat mothers during pregnancy with direct-acting antiviral agents (DAAs) to treat the mother before cirrhosis develops, prevent infant transmission, and prevent transmission to others. Children born to HCV-infected mothers may also be offered treatment at an early age to prevent cirrhosis, as well as transmission to others. Coordination of care between multiple specialists will be important to accomplish these goals.

Children of HCV-infected mothers may be screened for hepatitis C as early as 1-2 months of age using hepatitis C viral load or PCR testing (See Blood tests for hepatitis C). Antibodies to hepatitis C passed from the mother to child will be present for up to 18 months, so children should be tested for HCV antibody no earlier than this.

What type of doctor treats hepatitis C?

Hepatitis C is treated by either a gastroenterologist, a hepatologist (a gastroenterologist with additional training in liver disease), or an infectious disease specialist. The treatment team may include more than one specialist, depending on the extent of liver damage. Surgeons who specialize in surgery of the liver, including liver transplantation, are part of the medical team and should see patients with advanced disease (liver failure or cirrhosis) early before the patient needs a liver transplant. They may be able to identify issues that need to be addressed before surgery can be considered. Other persons who can be helpful in managing patients include dietitians to consult on nutritional issues and pharmacists to assist with the management of drugs.

How is hepatitis C diagnosed?

Blood tests for hepatitis C

There are several blood tests for the diagnosis of hepatitis C infection. Blood can be tested for antibody to hepatitis C (anti-HCV antibody). It takes about 8-12 weeks on average, and up to 6 months, for antibodies to develop after the initial infection with hepatitis C, so screening for antibodies may miss a few newly infected individuals. Having antibodies is not an absolute indication of active, multiplying hepatitis C virus, but if the antibody test is positive (antibody is present), the statistical probability of active infection is greater than 99%.

Several tests are available to measure the amount of hepatitis C virus in a person’s blood (the viral load). The hepatitis C virus’s RNA can be identified by a type of test called polymerase chain reaction (PCR) that detects circulating the virus in the blood as early as 2-3 weeks after infection, so it can be used to detect suspected acute infection with hepatitis C early infection. It also is used to determine whether active hepatitis is present in someone who has antibodies to hepatitis C and to follow the viral load during treatment.

Blood tests are also performed to identify the genotypes of HCV. Genotypes respond differently to different treatments, so this information is important in the selection of the most appropriate treatment regimen.

Estimation of liver fibrosis using blood tests also is quite reliable in diagnosing clinically significant scarring; these include FIB-4, FibroSure, Fibrotest, and aspartate aminotransferase-to-platelet ratio index (APRI).

Liver biopsy and non-invasive tests for hepatitis C

The next step is to determine the level of liver scarring that has occurred. A liver biopsy allows examination of a small sample of liver tissue under a microscope, however, liver biopsy is an invasive test and has significant risks of bleeding. It also might miss abnormal areas in early disease.

Non-invasive tests have largely replaced liver biopsy except in special situations. Liver stiffness indicates that advanced liver scarring or cirrhosis may be present. Transient elastography may be used to measure this stiffness by ultrasound or magnetic resonance imaging (MRI).

Pre-treatment evaluation for hepatitis C also should include:

  • Testing for HIV
  • Testing for antibodies to hepatitis B and hepatitis A and vaccination if antibodies are not present
  • If past or current hepatitis B infection is detected, it may need to be treated at the same time. There are reports of hepatitis B that reactivated or progressed to serious liver failure or death in some patients who were treated only for hepatitis C. This has been reported to occur during or even after HCV treatment.
  • Recommending abstinence from alcohol use
  • Counseling about measures to prevent the spread of hepatitis C and HIV
  • If cirrhosis is present, vaccination against pneumococcal infection, regardless of age

What medications cure hepatitis C infection?

Interferons, for example, Roferon-A and Infergen, and pegylated interferons such as Peg-IntronT, Pegasys, were mainstays of treatment for years. Interferons produced sustained viral response (SVR, or cure) of up to 15%. Later, peglatedll forms produced SVR of 50%-80%. These drugs were injected, had many adverse effects, required frequent monitoring, and were often combined with oral ribavirin, which caused anemia. Treatment durations ranged up to 48 weeks.

Direct-acting antiviral agents (DAAs) are antiviral drugs that act directly on hepatitis C multiplication.

  • They are taken by mouth, are well tolerated, and cure over 90% of patients.
  • Treatment time is much shorter, often 12 weeks, depending on drug and genotype.
  • Similar to treatments for HIV, treatment of HCV is most effective if the drugs are given in combination.
  • The earliest options were sofosbuvir (Sovaldi) and simeprevir (Olysio). These were approved by the FDA in 2013.
  • Ledipasvir and sofosbuvir (Harvoni) followed as a once-a-day combination pill, in 2014.
  • With this combination of DAAs, about 94%-99% of people achieve an SVR (cure) in 12 weeks with few side effects.
  • Ombitasvir, paritaprevir, and ritonavir co-packaged with dasabuvir tablets (Viekira Pak), is a combination approved in 2014. SVR with this combination is 91%-100%. The combination of elbasvir and grazoprevir (Zepatier) was approved in 2016. SVR with this combination depends on the HCV genotype and whether individual patient factors require the addition of ribavirin. Genotype 1 has a 94%-97% SVR, and SVR is 97%-100% in genotype 4.
  • In August 2017, FDA approved an 8-week regimen of glecaprevir and pibrentasvir (Mavryet) for all HCV genotypes. Unlike some of the earlier regimens, this combination is effective whether or not the patient has cirrhosis. It also can be given to people on kidney dialysis, whose kidney function limits treatment options. Moreover, this regimen is effective in people with genotype 1 who have failed treatment with some of the other regimens.

What are the treatment guidelines for hepatitis C?

Hepatitis C treatment is best discussed with a doctor or specialist familiar with current and developing options as this field is changing, and even major guidelines may become outdated quickly.

The latest treatment guidelines by the American Association for the Study of Liver Disease (AASLD) and Infectious Disease Society of America (IDSA) recommends the use of DAAs as first-line treatment for hepatitis C infection. The choice of DAA varies by specific virus genotype and the presence or absence of cirrhosis. In the U.S., specific insurance providers also might influence the choice due to the high cost of DAAs. Although the individual, public health, and cost benefits of treating all patients with hepatitis C are clear, the most difficult barrier to treating all people with HCV is the very high cost of the drug regimens. Patients are encouraged to discuss options with their health care professional.

Treatment is recommended in all patients with chronic hepatitis C unless they have a short life expectancy that is not related to liver disease. Severe life-threatening liver disease may require liver transplantation. Newer therapies with DAAs have allowed more and more patients to be treated.

What are the goals of therapy for hepatitis C infection?

The ultimate goals of antiviral therapy are to

  • prevent transmission of hepatitis C,
  • normalize liver tests,
  • reduce inflammation and scarring,
  • prevent progression to cirrhosis and liver cancer, and
  • improve survival and quality of life.

A side goal is preventing co-infections with other hepatitis viruses, such as A and B, which can cause more liver disease than HCV alone. These can be prevented by vaccines and treatment.

What is the treatment for people with acute hepatitis C infection?

When people first get hepatitis C, the infection is said to be acute. Most people with acute hepatitis C do not have symptoms so they are not recognized as being infected. However, some have a low-grade fever, fatigue or other symptoms that lead to an early diagnosis. Others who become infected and have a known exposure to an infected source, such as a needlestick injury, are monitored closely.

Treatment decisions should be made on a case-by-case basis. Response to treatment is higher in acute hepatitis infection than chronic infection. However, many experts prefer to hold off treatment for 8-12 weeks to see whether the patient naturally eliminates the virus without treatment. Approaches to treatment are evolving. Patients with acute hepatitis C infection should discuss treatment options with a health care professional who is experienced in treating the disease. There is no established treatment regimen at this time.

How effective is hepatitis C treatment? Is hepatitis C curable?

If the hepatitis C RNA remains undetectable at the end of the treatment and follow-up period, this is called a sustained virologic response (SVR) and is considered a cure. Over 90% of people treated with DAAs are cured. These people have significantly reduced liver inflammation, and liver scarring may even be reversed.

About 5% of people who are treated for HCV infection are not cured by some of the older regimens. These people may still have options for cure with the newer regimens.

Who should not receive treatment with antiviral therapy?

Few people with hepatitis C are at risk for problems if they are treated, however, there are some factors that affect treatment regimens, such as concurrent HIV medications and kidney dysfunction. Some drugs are not safe for people with cirrhosis. Individuals who are unable to comply with the treatment schedule for psychological reasons or ongoing drug or alcohol abuse may not be good candidates for treatment because the drugs are very costly and require adherence to the pill regimen and regular follow-up visits. There are some important drug interactions with some of the medications that should be considered by the health care professional.

People with past hepatitis B or who have chronic active hepatitis B should not be treated for HCV without treating HBV as well. As a highly effective treatment for HCV has emerged, reports of serious hepatitis B have come to light. Similar to HCV, hepatitis B usually does not clear from the liver after acute infection, even though it is far less likely to cause chronic active hepatitis than hepatitis C infection. It remains dormant in most people, but it can reactivate with changes in the immune system. It is not clear why eliminating the HCV can allow the HBV infection to flare up. Hepatitis B screening is an important part of the hepatitis C evaluation. Those who have laboratory evidence of active or past infection with HBV should be monitored while receiving HCV treatment.

What are the side effects of treatments for hepatitis C infection?

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Side effects of interferon or pegylated interferon

  • The most common side effects of interferon or pegylated interferon include fever, flu-like symptoms, and depression. Patients must be monitored closely for depression. The risk of suicide is a reason to avoid interferons.
  • Interferons also reduce white blood cell and/or red blood cell counts (leucopenia and anemia, respectively). This may cause increased susceptibility to infection. Interferons also increase the risk of certain cancers. Death rarely occurs as a result of therapy, but may occur from the progression of liver failure in patients with advanced cirrhosis.

Side effects of ribavirin

  • Ribavirin most commonly causes anemia due to the destruction of red blood cells (hemolysis). This can be severe enough that people with heart disease may suffer a heart attack from insufficient blood flow, so people with heart disease should not receive this drug. Anemia improves with a reduction in the dose of ribavirin. Injected growth factor (erythropoietin) that stimulates the production of red blood cells often is used to improve the anemia associated with ribavirin. Ribavirin also accumulates in the testicles and ovaries and causes birth defects in animals. Although no birth defects have been reported in humans, both men and women should use contraceptive measures to avoid pregnancy during and for at least six months after ribavirin treatment.

Side effects of DAAs

Compared to interferons and ribavirin drugs, the side effects of DAAs are far fewer and more tolerable. These side effects usually do not require discontinuation of therapy and are self-limiting after completion of therapy.

  • The most common and significant side effects of boceprevir (Victrelis), sofosbuvir (Sovaldi), and ledipasvir/sofosbuvir (Harvoni) include
    • fatigue (feeling tired),
    • headache, and
    • trouble sleeping (insomnia).
  • The most common side effects of simeprevir (Olysio) include
    • itching,
    • skin rash, and
    • photosensitivity (tendency to get sunburns).
  • Simeprevir has significant drug interactions with other medications. Certain medications can affect levels of simeprevir in the body and make simeprevir less effective or more toxic.
  • The combination of ombitasvir, paritaprevir, and ritonavir tablets with dasabuvir tablets (Viekira Pak) is very well tolerated, and the most commonly reported side effects are
    • fatigue,
    • trouble sleeping, and
    • itching.
  • The combination of elbasvir and grazoprevir (Zepatier) is well-tolerated. Most common side effects include
    • fatigue,
    • headache, and
    • nausea.
    • It may be used with ribavirin, which adds the side effect of anemia.
    • About 1% of people in studies may develop elevated liver enzyme blood tests last into treatment or afterward, so these tests are closely monitored.
  • The combination of glecaprevir and pibrentasvir (Mavryet) is well tolerated. Most common side effects include
    • fatigue,
    • headache, and
    • nausea.
  • The use of milk thistle should be discussed with the treating doctor because it interacts with several DAAs.

Patients with hepatitis B co-infection should be monitored for symptoms of reactivation of hepatitis, which are the same as the symptoms of acute hepatitis. The treating doctor may perform blood screening for this as well.

Frequently Asked Questions About Hepatitis C

What is hepatitis?

Hepatitis means inflammation of the liver. When the liver is inflamed or damaged, its function can be affected. Heavy alcohol use, toxins, some medications, and certain medical conditions can all cause hepatitis. However, hepatitis is often caused by a virus. In the United States, the most common hepatitis viruses are hepatitis A virus, hepatitis B virus, and hepatitis C virus.

What is the difference between hepatitis A, hepatitis B, and hepatitis C?

Hepatitis A, hepatitis B, and hepatitis C are liver infections caused by three different viruses. Although each can cause similar symptoms, they are spread in different ways and can affect the liver differently. Hepatitis A is usually a short-term infection. Hepatitis B and hepatitis C can also begin as short-term infections but in some people, the virus remains in the body and causes chronic (lifelong) infection. There are vaccines to prevent hepatitis A and hepatitis B; however, there is no vaccine for hepatitis C.
The page “What is viral hepatitis?” explains in detail the differences between hepatitis A, hepatitis B, and hepatitis C.

What is hepatitis C?

Hepatitis C is a liver infection caused by the hepatitis C virus. Hepatitis C can range from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis C is often described as “acute,” meaning a new infection or “chronic,” meaning lifelong infection.

  • Acute hepatitis C occurs within the first 6 months after someone is exposed to the hepatitis C virus. Hepatitis C can be a short-term illness, but for most people, acute infection leads to chronic infection.
  • Chronic hepatitis C can be a lifelong infection with the hepatitis C virus if left untreated. Left untreated, chronic hepatitis C can cause serious health problems, including liver damage, cirrhosis (scarring of the liver), liver cancer, and even death.

What is the likelihood that acute hepatitis C will become chronic?

Approximately 75%–85% of people who become infected with the hepatitis C virus will develop a chronic infection.

Is it possible to clear the hepatitis C virus?

Yes, approximately 15%–25% of people who are infected with the hepatitis C virus clear it from their bodies without treatment and do not develop chronic infection. Experts do not fully understand why this happens to some people.

How common is acute hepatitis C in the United States?

In 2017, a total of 3,186 cases of acute hepatitis C were reported to CDC. Since many people may not have symptoms or don’t know they are infected, their illness is often not diagnosed or reported and therefore can’t be counted. CDC estimates the actual number of acute hepatitis C cases was closer to 44,300 in 2017.

How common is chronic hepatitis C in the United States?

In 2016, there were an estimated 2.4 million people living with hepatitis C in the United States.

How is hepatitis C spread?

Hepatitis C is usually spread when blood from a person infected with the hepatitis C virus enters the body of someone who is not infected. Today, most people become infected with the hepatitis C virus by sharing needles or other equipment to prepare or inject drugs. Before 1992, hepatitis C was also commonly spread through blood transfusions and organ transplants. After that, widespread screening of the blood supply in the United States virtually eliminated this source of infection.

People can become infected with the hepatitis C virus during such activities as:

  • Sharing needles, syringes, or other equipment to prepare or inject drugs
  • Needlestick injuries in health care settings
  • Being born to a mother who has hepatitis C

Less commonly, a person can also get hepatitis C virus through

  • Sharing personal care items that may have come in contact with another person’s blood, such as razors or toothbrushes
  • Having sexual contact with a person infected with the hepatitis C virus
  • Getting a tattoo or body piercing in an unregulated setting

Hepatitis C virus is not spread by sharing eating utensils, breastfeeding, hugging, kissing, holding hands, coughing, or sneezing. It is also not spread through food or water.

Can I be re-infected with hepatitis C virus if I have cleared the virus?

Yes. If you have been infected with the hepatitis C virus and cleared the virus, or if you have been successfully treated and cured, you can be re-infected with the hepatitis C virus.

Can hepatitis C virus be spread through sexual contact?

Yes, but the risk of transmission from sexual contact is believed to below. The risk increases for people who have multiple sex partners, have a sexually transmitted disease, engage in rough sex, or are infected with HIV.

Can you get hepatitis C by getting a tattoo or piercing?

A few major research studies have not shown hepatitis C to be spread through licensed, commercial tattooing facilities. However, the transmission of hepatitis C (and other infectious diseases) is possible when poor infection-control practices are used during tattooing or piercing. Unregulated tattooing and piercing are known to occur in prisons and other informal settings and may put a person at risk of infection.

Can hepatitis C be spread within a household?

Yes, but this does not occur very often. If the hepatitis C virus is spread within a household, it is most likely a result of direct, through-the-skin exposure to the blood of an infected household member.

Who is at risk for hepatitis C?

Some people are at increased risk of having hepatitis C, including:

  • Current or former injection drug users, including those who injected only once many years ago
  • Those born from 1945 through 1965
  • Recipients of clotting factor concentrates made before 1987 when less advanced methods for manufacturing those products were used
  • Recipients of blood transfusions or solid organ transplants prior to July 1992, before better testing of blood donors, became available
  • Hemodialysis patients
  • People with known exposures to the hepatitis C virus, such as
    • Health care workers after needle sticks involving blood from someone who is infected with the hepatitis C virus
    • Recipients of blood or organs from a donor who tested positive for the hepatitis C virus
  • People with HIV infection
  • Children born to mothers infected with the hepatitis C virus
  • People who are incarcerated
  • People who use intranasal drugs
  • People who received body piercing or tattoos done with non-sterile instruments

What is the risk of a pregnant woman passing hepatitis C to her baby?

About 6 in 100 infants born to mothers with hepatitis C become infected with the hepatitis C virus. However, the risk becomes greater if the mother has both HIV and hepatitis C.

Can a person get the hepatitis C virus from a mosquito or other insect bite?

No, the hepatitis C virus has not been shown to be transmitted by mosquitoes or other insects.

Can I donate blood if I have tested positive for hepatitis C?

The American Red Crossexternal icon does not accept blood donations from anyone with current signs or symptoms of hepatitis, or if you have ever tested positive for hepatitis C.

Can someone with hepatitis C donate organs?

According to the U.S. Department of Health & Human Service’s online information on organ donation and transplantation-external icons, very few conditions would prevent someone from being an organ, eye, or tissue donor. Even with acute or chronic hepatitis C, you may be able to donate your organs or tissues. The transplant team will determine what organs or tissue can be used based on clinical evaluation, medical history, and other factors.

What are the symptoms of acute hepatitis C?

People with new (acute) hepatitis C virus infection usually do not have symptoms or have mild symptoms. When symptoms do occur, they can include:

  • Fever
  • Fatigue
  • Dark urine
  • Clay-colored bowel movements
  • Abdominal pain
  • Loss of appetite
  • Nausea
  • Vomiting
  • Joint pain
  • Jaundice (yellow color in the skin or eyes)

How soon after exposure to the hepatitis C virus do symptoms appear?

In those people who develop symptoms from acute infection, the average time from exposure to symptoms ranges from 2 to 12 weeks. However, most people who are infected with the hepatitis C virus do not develop symptoms.

Can a person spread hepatitis C without having symptoms?

Yes, even if a person with hepatitis C has no symptoms, he or she can still spread the hepatitis C virus to others.

Is it possible to have hepatitis C and not know it?

Yes, many people who are infected with the hepatitis C virus do not know they are infected because they do not look or feel sick.

What are the symptoms of chronic hepatitis C?

Most people with chronic hepatitis C virus infection do not have any symptoms or have general, or common symptoms such as chronic fatigue and depression. Many people eventually develop chronic liver disease, which can range from mild to severe, including cirrhosis (scarring of the liver) and liver cancer. Chronic liver disease in people with hepatitis C usually happens slowly, without any signs or symptoms, over several decades. Chronic hepatitis C virus infection is often not recognized until people are screened for blood donation or from an abnormal blood test found during a routine examination.

How serious is chronic hepatitis C?

Chronic hepatitis C can be a serious disease resulting in long-term health problems, including liver damage, liver failure, liver cancer, or even death. It is a major cause of cirrhosis and liver cancer and the most common reason for liver transplantation in the United States. There were 18,153 deaths related to the hepatitis C virus reported to the CDC in 2016, but this is believed to be an underestimate.

What are the long-term effects of hepatitis C?

Of every 100 people infected with the hepatitis C virus:

  • 75-85 will develop chronic infection
  • 10-20 will develop cirrhosis over 20-30 years

Among 100 people with hepatitis C and cirrhosis, with each passing year:

  • 3-6 will develop liver failure
  • 1-5 will develop liver cancer

Developing cirrhosis is more likely if you are male, age 50 years and older, use alcohol, have nonalcoholic fatty liver disease, hepatitis B virus or HIV coinfection, or take immunosuppressive drugs.

Who should get tested for hepatitis C?

CDC recommends hepatitis C testing for:

  • Current or former injection drug users, including those who injected only once many years ago
  • Everyone born from 1945  to 1965
  • Anyone who received clotting factor concentrates made before 1987
  • Recipients of blood transfusions or solid organ transplants prior to July 1992
  • Long-term hemodialysis patients
  • People with known exposures to the hepatitis C virus, such as
    • health care workers or public safety workers after needle sticks involving blood from someone infected with the hepatitis C virus
    • recipients of blood or organs from a donor who tested positive for the hepatitis C virus
  • People with HIV infection
  • Children born to mothers with hepatitis C

Other experts, including a group that helps set health policies in the United States, called the U.S. Preventive Services Task Force (USPSTF) recommends hepatitis C virus testing external icon for additional groups including:

  • People in jails or prisons
  • People who use drugs snorted through the nose (in addition to people who inject drugs),

People who get an unregulated tattoo

Getting tested for hepatitis C is not part of routine prenatal care. However, if you are a pregnant woman who has risk factors for hepatitis C virus infection, you should speak to your doctor about getting tested.

Should a woman with hepatitis C virus infection avoid breastfeeding?

No. There is no evidence that breastfeeding spreads the hepatitis C virus. Precautions may be considered if mothers with hepatitis C have cracked or bleeding nipples because there is not enough information on the risks of transmission when this happens.

What blood tests are used to test for hepatitis C?

The only way to know if you have hepatitis C is to get tested and you may need more than one type of test. A blood test, called a hepatitis C antibody test, can tell if you have ever been infected with the hepatitis C virus. Antibodies are chemicals released into the bloodstream when someone gets infected. Another test, called a hepatitis C virus RNA test, can tell if you have a current infection with the hepatitis C virus. RNA is the virus’s genetic material.

What blood tests are used to test for hepatitis C?

The only way to know if you have hepatitis C is to get tested and you may need more than one type of test. A blood test, called a hepatitis C antibody test, can tell if you have ever been infected with the hepatitis C virus. Antibodies are chemicals released into the bloodstream when someone gets infected. Another test, called a hepatitis C virus RNA test, can tell if you have a current infection with the hepatitis C virus. RNA is the virus’s genetic material.

How do I interpret the results of the hepatitis C antibody test?

There are two possible antibody test results:

  • Non-reactive, or a negative, means that a person has never had hepatitis C. However, if a person has been recently exposed to the hepatitis C virus, he or she will need to be tested again.
  • Reactive, or a positive, means that hepatitis C antibodies were found in the blood and a person has been infected with the hepatitis C virus at some point in time. A reactive antibody test does not necessarily mean a person has hepatitis C. Once someone has been infected, they will always have antibodies in their blood. This is true if even if they have cleared the hepatitis C virus.

A reactive antibody test requires an additional test, called a hepatitis C virus RNA test (or PCR), to confirm whether the virus is still present in the person’s bloodstream.

How soon after exposure to the hepatitis C virus can the antibody test tell if someone is infected?

For most people exposed to the hepatitis C virus, the HCV antibody blood test will be positive in 4–10 weeks. About 97% of people infected will have a positive HCV antibody test 6 months after exposure.

How soon after exposure to the hepatitis C virus can hepatitis C virus be detected by a hepatitis C virus RNA (PCR) test?

A special kind of blood test called a hepatitis C virus RNA test (or PCR) can tell if a person is infected in 2–3 weeks after exposure.

Can a person have a normal liver enzyme (e.g., ALT) level and still have hepatitis C?

Yes. It is common for persons with chronic hepatitis C to have a liver enzyme level that goes up and down, with periodic returns to normal or near normal. Some people with hepatitis C have liver enzyme levels that are normal for over a year even though they have chronic liver disease.

What is the treatment for acute hepatitis C?

There is not a recommended treatment for acute hepatitis C. People with acute hepatitis C virus infection should be followed by a doctor and only considered for treatment if their infection remains and becomes a chronic infection.

What is the treatment for chronic hepatitis C?

There are several medications available to treat chronic hepatitis C. Hepatitis C treatments have gotten much better in recent years. Current treatments usually involve just 8-12 weeks of oral therapy (pills) and cure over 90% of people with few side effects. For a complete list of currently approved FDA treatments for hepatitis C, please visit http://www.hepatitisc.uw.edu/page/treatment/drugsexternal icon.

What can a person with chronic hepatitis C do to take care of his or her liver?

First, people with chronic hepatitis C should talk to their doctor about treatments, even if they have been treated for hepatitis C in the past. For people with cirrhosis, there is a continued risk of liver cancer even after hepatitis C virus infection is cured. People with chronic hepatitis C and people with cirrhosis (even if they have been cured for hepatitis C) should be monitored regularly by a doctor and be vaccinated against hepatitis A and hepatitis B. People with chronic hepatitis C should avoid alcohol because it can cause additional liver damage. They also should check with their doctor before taking any prescription pills, herbs, supplements, or over-the-counter medications, as these can potentially damage the liver.

Is there a vaccine that can prevent hepatitis C?

No. Research into the development of a vaccine for hepatitis C is underway. Vaccines are available for hepatitis A and hepatitis B.

Should a person infected with the hepatitis C virus be restricted from working in certain jobs or settings?

CDC’s recommendations for prevention and control of the hepatitis C virus infection state that people should not be excluded from work, school, play, childcare, or other settings because they have hepatitis C virus infection. There is no evidence that people can get hepatitis C from food handlers, teachers, or other service providers without blood-to-blood contact.

Can a person be infected with HIV and the hepatitis C virus?

Yes, a person can be infected with both HIV and hepatitis C virus. This is sometimes called “coinfection.” To learn more about coinfection, read HIV and Viral Hepatitis pdf icon[PDF – 2 pages].

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