What is hepatitis C?
Hepatitis C is a viral infection that affects your liver. It causes inflammation and swelling, which damages your liver tissues over time. “Hepatitis” means inflammation of the liver. There are many causes of hepatitis, and a few of them are viruses. Compared to other causes of viral hepatitis, though, hepatitis C is much more likely to stay in your body for a long time.
Chronic inflammation over many years does serious damage to your liver. In fact, hepatitis C is one of the leading causes of liver failure and liver transplantation in the United States. Most people can’t tell when their liver is inflamed. They don’t develop symptoms until severe damage has already been done.
How common is hepatitis C?
Rates of hepatitis C infection in the U.S. have nearly quadrupled in the last decade. According to the Centers for Disease Control and Prevention, nearly 4 million people in the United States today may have hepatitis C. Many are unaware. The CDC now recommends that all U.S. adults be screened for hepatitis C. Worldwide, the estimated number of infections is 60 million.
What is the main cause of hepatitis C?
Hepatitis C is caused by a virus that spreads through contact with blood. Transmission occurs when the blood of an infected person enters the body of an uninfected person. In the U.S., it most commonly occurs when people share needles for injecting intravenous drugs. Worldwide, transmission commonly occurs in medical settings with unsterilized equipment.
What is the difference between hepatitis A, B and C?
Hepatitis A and hepatitis B are different viruses that also cause hepatitis. They differ in the ways they’re contracted and spread, the types of infections they cause and the ways that you can treat them and prevent them. Here are some of the key differences:
|Hepatitis A||Has vaccine||Through feces||Acute only. Resolves by itself in a few weeks.||May not be necessary. The vaccine may help if you haven’t had it yet.|
|Hepatitis B||Has vaccine||Through blood||Chronic in only 5% of adults but in 30% of children under 5.||Antivirals can help to control chronic infection, but they don’t cure it.|
|Hepatitis C||Has no vaccine||Through blood||Chronic in 80% of people.||Antivirals can cure 95–98% of chronic infections.|
How does hepatitis C infection affect me?
Hepatitis C infection has several stages.
When you first get a virus, it goes through what’s called an incubation period. This is when it’s busy replicating itself in your body. The virus keeps replicating until it reaches the threshold where your body recognizes the infection. Then your immune system kicks in, and that’s when you begin to notice symptoms.
With hepatitis C, the incubation period can last from two weeks to six months. The acute stage of infection begins when your immune system kicks in. It’s also when you begin to experience symptoms. Most viral infections at the acute stage cause symptoms of illness, such as fever and inflammation in your body. With hepatitis, though, the inflammation is mainly in your liver, and you might not notice it.
Only 20% of people with acute hepatitis C infection have symptoms. People who have symptoms can treat the infection with antivirals. But most don’t have symptoms and don’t know to seek treatment. The acute stage lasts up to three months. Within this period, up to 20% of people effectively fight off the virus and spontaneously clear it from their bodies.
Most people (80%) are unable to clear the virus by themselves and develop a long-term, chronic infection. This means that their livers are constantly inflamed and swollen. Chronic hepatitis causes liver damage by a process known as cirrhosis. The constant inflammation of the liver eventually leads to scarring.
Cirrhosis progresses slowly over several decades. It might go faster if you have additional liver damage from other causes, such as excessive alcohol use. It might go slower if your liver is in better condition overall. But the end result is that scar tissue prevents your liver from doing its job. The risk of cirrhosis from chronic hepatitis C infection is about 25% after 20 years.
Symptoms and Causes
How do you get hepatitis C?
The hepatitis C virus (HCV) spreads through contact with blood. Transmission occurs when the blood of an infected person enters the body of an uninfected person. In the U.S., the most common way this happens is by sharing needles for injecting intravenous drugs. But there are all sorts of accidental ways that you might come into contact with another person’s blood.
- Exposure to needles or sharp objects at work, especially in healthcare.
- Tattoos or body piercings performed with unsterilized equipment.
- Sharing a razor or toothbrush with somebody who might have bled using it.
- Less commonly, through sexual contact that leads to blood exposure.
Before 1992, hepatitis C was commonly spread through blood transfusions and organ transplants. Now, healthcare providers routinely screen for the virus before using donated blood or organs. While it’s no longer a risk from these causes, healthcare providers recommend that everyone who did receive a transfusion or transplant before 1992 get tested for HCV.
Who is most commonly affected by hepatitis C infection?
In the U.S., you’re more likely to be infected with hepatitis C if you:
- Use intravenous drugs.
- Have HIV.
- Received a blood transfusion or organ transplant before 1992.
- Received blood clotting factor for hemophilia before 1987.
- Were born between 1945 and 1965.
- Were born to a mother with hepatitis C.
What are the symptoms of hepatitis C?
Most people don’t have any symptoms. A small number may have symptoms during the acute stage of infection. They may be vague, flu-like symptoms, or they may be like the symptoms of liver disease, including stomach pain and jaundice. Much later on, you may begin to notice symptoms of late-stage liver disease when your liver is beginning to fail.
What are the early warning signs of hepatitis C?
Acute symptoms of hepatitis C infection may resemble flu symptoms, such as:
They may also resemble the symptoms of acute liver failure, such as:
- Jaundice (yellowing of lighter skin and the whites of the eyes).
- Abdominal pain (especially in the upper right quadrant).
- Nausea and vomiting.
- Dark-colored pee and light-colored poop.
What are the symptoms of advanced liver disease?
If you don’t have early warning symptoms, you may have late warning symptoms of hepatitis when you begin to experience the effects of cirrhosis after many years of chronic infection. You may have all of the symptoms above, and may also notice:
- Swelling with fluid in your arms and legs (edema).
- Swelling with fluid in your abdomen (ascites).
- Itchy skin.
- Unexplained weight loss.
- Easy bruising and bleeding.
- Difficulty thinking or remembering, confusion (hepatic encephalopathy).
Diagnosis and Tests
How is hepatitis C diagnosed?
Screening for hepatitis C infection begins with a simple blood test. Your healthcare provider will draw a small amount of blood from a vein in your arm and send it to the lab for testing. If you’ve been infected with the virus, your blood sample will have antibodies against hepatitis C. If you test positive for antibodies, your healthcare provider will follow up with additional blood tests.
A blood test called an RNA PCR test looks for evidence of the actual virus in your blood, not just the antibodies. This test is necessary to confirm that you’re still infected. You might still have antibodies even if you’ve spontaneously cleared the virus. Your provider can also use this test to measure the quantity of the virus in your blood and to find out which strain you have.
What other medical tests will I have?
If you test positive for chronic hepatitis C infection, your healthcare provider will want to assess your liver for damage. They’ll want to know how much of your liver tissue has turned to scar tissue. Tests to evaluate the health of your liver may include:
- Liver function tests. Liver function tests are a series of blood tests that evaluate the health of your liver.
- Elastography. An elastography is a noninvasive imaging test that measures the stiffness or fibrosis of your liver tissue. It uses ultrasound or MRI.
- Liver biopsy. As a last resort, when other tests aren’t conclusive, your healthcare provider may take a sample of tissue from your liver to test in the lab. They can usually do this through a hollow needle inserted through your abdominal wall in a simple bedside procedure.
Management and Treatment
Does hepatitis C go away?
It doesn’t usually go away without treatment, but occasionally it does. If you’re among the few who are able to spontaneously clear the virus, this will happen during the acute stage of infection. The acute stage is when your immune system launches its initial attack on the virus. It lasts up to three months. If it succeeds, you won’t develop a chronic infection.
If you do have a chronic infection, it means that the virus has outwitted your immune system and you’ll need help to clear it. Fortunately, recent advances in antiviral medications have made this possible. New antivirals can cure chronic hepatitis C infection in 95–98% of cases, within eight to 24 weeks. Due to their side effects, they may not be suitable for everyone.
What is the treatment for hepatitis C?
There are a variety of medications now available to treat hepatitis C. Different medications are recommended to treat different strains of the virus. The length of treatment may depend on your overall condition and the strain (or genotype) you have. Some respond better to treatment than others.
Medications approved for the treatment of hepatitis C include:
- Sofosbuvir (Sovaldi®).
- Ledipasvir/sofosbuvir (Harvoni®).
- Simeprevir (Olysio®).
- Paritaprevir/ombitasvir/ritonavir/dasabuvir (Viekira Pak®).
- Daclatasvir (Daklinza®).
- Elbasvir/grazoprevir (Zepatier®).
- Sofosbuvir/velpatasvir (Epclusa®).
- Glecaprevir/pibrentasvir (Mavyret®).
- Sofosbuvir/velpatasvir/voxilaprevir (Vosevi®).
- Ombitasvir/paritaprevir/ritonavir (Technivie®).
- Ribavirin (RibaPak®).
- Peginterferon alfa-2a/2b (Pegasys®/PEG-Intron®).
Will I need additional treatment?
If you already have advanced liver disease (cirrhosis), curing the infection may not be enough. You may already be on the threshold of liver failure. The only cure for liver failure is liver transplantation. If your healthcare provider determines that you need a new liver, you’ll have to join the waiting list. In the meantime, curing hepatitis C is still important to protect the health of your new liver.
Is there a hepatitis C vaccine?
There’s currently no effective vaccine to prevent hepatitis C. Although researchers have been working on it for a long time, hepatitis C has proven difficult to prevent because it has many variations and mutates rapidly. The only effective way to prevent hepatitis C infection is to avoid contact with infected blood. In particular, don’t share needles or syringes.
Outlook / Prognosis
What is the prognosis for someone with chronic hepatitis C?
New medications for hepatitis C have made the prognosis (outlook) brighter. Even if you’ve had a chronic infection for many years, you can treat it and, in most cases, cure it in a matter of weeks. However, some people may have extensive liver damage before they ever seek treatment. There’s no way of knowing how your liver is doing without taking some tests.
A note from Cleveland Clinic
Everyone should be screened at least once for hepatitis C infection. It’s a simple blood test that could provide life-changing information about your health. Risky behaviors such as intravenous drug use put you at higher risk. But when overall infection rates are high and many people don’t know they’re infected, it’s not impossible for anyone to have the virus.
The good news is that hepatitis C is curable. You can prevent significant liver damage by catching and treating the infection earlier than later. Don’t wait for symptoms, which may never occur, or may only occur when it’s too late. Knowledge is power, and even with advanced liver disease, there are steps you can take to control the damage and preserve your liver.
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