Hepatitis C

Hepatitis C (hep C) is a viral infection that causes inflammation in your liver. This can lead to serious liver damage. The hepatitis C virus (HCV) spreads through contact with infected blood. Many people with hepatitis C don’t have symptoms. So, they may not know they’re infected. Because of this, the U.S. Preventive Services Task Force recommends a one-time hepatitis C screening for all adults ages 18 to 79.

Hepatitis C can be acute or chronic:

• Acute hepatitis C is the early stage of infection. It lasts up to six months after you’re exposed to the virus. In many cases, people don’t have symptoms during this time. About 3 out of 4 people with acute hepatitis C develop chronic hepatitis C.
• Chronic hepatitis C means the virus stays in your body for longer than six months. It can slowly damage your liver over time. Without treatment, it can lead to serious problems, like cirrhosis (liver scarring) or liver failure.

In the United States, researchers estimate that more than 2 million people have chronic hepatitis C.

Hepatitis C symptoms

Most people with hep C have no symptoms or only mild, nonspecific ones. When symptoms do occur, they may include:

• Belly (abdominal) pain
• Body aches
• Feeling very tired (fatigue)
• Loss of appetite
• Nausea and vomiting
• Joint pain
• Fever
• Dark-colored pee (urine)
• Gray- or clay-colored poop (stool)
• A general feeling of illness (malaise)
• Yellowing of your skin or the whites of your eyes (jaundice)

How do you get hepatitis C?

The hepatitis C virus (HCV) causes hepatitis C. This virus infects your liver and leads to inflammation and damage. The virus spreads when infected blood enters your body. In many cases, people don’t know when or how they were exposed.

There are seven different types of the hep C virus. These are called genotypes. They vary in how they respond to treatment. In the U.S., genotype 1 is the most common.

Hepatitis C transmission

Hepatitis C is contagious, but it doesn’t spread through casual contact. It spreads when infected blood enters your body. The most common way it spreads is through sharing needles or other equipment used to inject drugs. Other ways it can spread include:

• Getting tattoos or body piercings with equipment that isn’t properly sterilized
• Accidental needle sticks in healthcare settings
• Sharing items that may have blood on them, like razors, toothbrushes or nail clippers
• Being born to someone who has hepatitis C

In the past, hep C sometimes spread through blood transfusions or organ transplants. But this is very rare in the U.S. now because providers screen the blood supply for the virus.

Hepatitis C doesn’t spread through breast milk, hugging, kissing, or sharing foods or drinks with an infected person.

Risk factors

Hepatitis C is more likely to affect people who have had contact with infected blood. Certain situations increase your risk. These include:

• Injecting drugs, especially if you share needles, syringes or other equipment
• Using drugs through your nose and sharing items like straws
• Receiving a blood transfusion, blood products or an organ transplant before 1992, when blood screening became routine in the U.S.
• Being on long-term kidney dialysis
• Living with HIV

If you’re at high risk, your healthcare provider may recommend screening for hepatitis C more often.

Complications of this condition

Hepatitis C can lead to serious liver damage over time, especially if the infection becomes chronic and you don’t get treatment. Possible complications of chronic hepatitis C include:

• Cirrhosis: This is when scar tissue replaces healthy liver tissue, which prevents your liver from working properly.
• Liver failure: Cirrhosis can eventually lead to liver failure, or end-stage liver disease. This means your liver is severely damaged. If your liver fails, you may need a liver transplant.
• Liver cancer: If you have cirrhosis or a lot of scar tissue, you have a higher risk of developing liver cancer.

How doctors diagnose this condition

Your healthcare provider will go over your medical history and ask if you have any symptoms. They’ll order a blood test to check for a hepatitis C infection.

Many people with hepatitis C don’t have symptoms. So, providers often recommend testing as part of hepatitis C screening. If a screening test suggests hepatitis C, your provider may order other tests.

Tests for hepatitis C infection

Healthcare providers mainly use two types of blood tests to diagnose hepatitis C:

• Antibody test: This test checks for antibodies that your immune system makes after exposure to the virus. A positive result means you’ve been exposed to hepatitis C at some point.
• RNA test: This test looks for the HCV virus itself. It shows whether the infection is currently active.

If hepatitis C is confirmed, your provider will order other tests to see how much of your liver is damaged. These may include:

• Liver function tests
• Tests to identify the genotype (type) of hepatitis C virus
• Imaging tests to check for liver damage or scarring

Hepatitis C treatment

Hep C treatment involves the use of antiviral medications that target the virus. Most people take a combination of medicines in pill form for eight to 12 weeks. But treatment may last longer depending on your situation. Treatment depends on several factors, including the type of hep C virus you have and the health of your liver.

Hepatitis C medication

Therapy for hep C involves the use of medicines called direct-acting antivirals (DAAs). These drugs work by blocking the virus from multiplying in your body. Common antiviral drugs for hepatitis C include:

• Elbasvir/grazoprevir (Zepatier^®)
• Glecaprevir/pibrentasvir (Mavyret^®)
• Ledipasvir/sofosbuvir (Harvoni^®)
• Sofosbuvir/velpatasvir (Epclusa^®)
• Sofosbuvir/velpatasvir/voxilaprevir (Vosevi^®)

In rare cases, your healthcare provider may also add another antiviral medication called ribavirin to help improve treatment results.

Is hep C curable?

Hep C is usually curable. More than 9 out of 10 people are cured if they take their medications exactly as their provider directed.

After treatment ends, your provider will do a blood test about 12 weeks later. If the HCV virus can’t be found in your blood, it means the infection has been cured.

Being cured means the virus is no longer damaging your liver. But it’s still possible to get hepatitis C again if you’re exposed to the virus in the future.

When should I see my healthcare provider?

See your provider if you think you may have been exposed to hep C. Contact them if you develop symptoms like:

• Extreme fatigue or weakness
• Loss of appetite
• Nausea or vomiting
• Muscle or joint pain
• Unexplained weight loss
• Belly pain, especially in the upper right side
• Dark pee or pale poop
• Jaundice

What is the outlook for people with hepatitis C?

The outlook for hepatitis C varies depending on whether the infection clears on its own or becomes chronic. Only about 1 to 2 people out of 10 clear the virus from their body without treatment. For most others, the infection becomes chronic.

Without treatment, chronic hepatitis C can slowly damage your liver. About 1 out of 5 people develop cirrhosis within 20 years. One to 5 out of 100 people develop liver cancer within 30 years.

How can I prevent hepatitis C?

Hepatitis C spreads through contact with infected blood. You can reduce your risk by avoiding situations where blood exposure may occur. Steps that can help prevent infection include:

• Don’t share needles or other equipment used to inject drugs.
• Avoid sharing personal items that may have blood on them.
• Make sure tattoos and piercings are done with sterile equipment and new, unopened ink.
• Use gloves if you need to handle another person’s blood or open wounds.

Currently, there is no vaccine to prevent hepatitis C.