What is hepatitis C?
Hepatitis C is an infection of the liver that is caused by a virus and spread through contact with the blood of an infected person. Some people can have hepatitis C for years without feeling sick, or may just have minor symptoms.
If the infection is not treated, it can cause the liver to swell and become inflamed. Over time, this can lead to cirrhosis of the liver, and possibly liver failure. As the disease develops, symptoms of liver damage may appear.
What are the types of hepatitis C infection?
There are two types of hepatitis C infection:
- Acute: a short-term infection that occurs within 6 months after a person is exposed to the virus. However, about 75 to 85 percent of people with the acute form go on to develop the chronic form.
- Chronic: a long-term illness that can continue throughout a person’s life. It can lead to cirrhosis (scarring) of the liver and other serious problems, such as liver failure or cancer. About 15,000 people a year die from liver disease associated with hepatitis C.
How common is hepatitis C?
Between 2.7 million and 3.9 million people in the United States have chronic hepatitis C. Hepatitis C is the leading cause of cirrhosis of the liver and liver cancer. It is the most common reason for liver transplants in the United States.
Symptoms and Causes
What causes hepatitis C?
Hepatitis C is caused when blood from an infected person enters the body of an uninfected person. These are the most common methods of infection:
- An infected person shares needles or syringes for injecting intravenous (IV) drugs. Even people who have used IV drugs infrequently may be at risk for infection.
- Healthcare workers who accidentally stick themselves with needles used on infected patients are at risk of getting hepatitis C.
- Patients who received donated blood or blood products or who had organ transplants before 1992 are at higher risk for hepatitis C.
Less common ways of spreading hepatitis C include the following:
- Sexual contact with an infected person. Although the risk of getting hepatitis C through sexual intercourse is low, the risk increases for people who have several sex partners or those with HIV infections.
- Sharing a razor, toothbrush or other personal item that may have come into contact with the blood of an infected person.
- Becoming infected through body piercing or tattooing, if the facility does not use sterile equipment or does not follow infection control practices.
Babies born to mothers who have hepatitis C might become infected, although this is not common. In addition, “baby boomers” (people born in the United States between 1945 and 1965) are at increased risk of having hepatitis C and should be screened for it.
Hepatitis C cannot be spread by simple contact (hugging, kissing, etc.) or by coughing or sneezing.
What are the symptoms of hepatitis C?
People who are infected with hepatitis C often do not have any symptoms. When symptoms do appear, they may be similar to those of flu. Symptoms usually take from 2 weeks to 6 months after exposure to the virus before they occur.
Symptoms of acute hepatitis C may include:
- Achiness in the joints or muscles
- Mild fatigue (feeling tired)
- Nausea (feeling sick to the stomach)
- Loss of appetite
- Tenderness in the area of the liver
Symptoms of liver damage associated with chronic hepatitis may include jaundice (yellowing of the skin and whites of the eyes), itching, and slowed thinking.
Diagnosis and Tests
How is hepatitis C diagnosed?
The doctor will take the patient’s medical history and perform a physical examination. As part of the physical exam, the doctor will look for signs of liver damage, including tenderness in the abdomen, swelling in the legs, feet or ankles, or signs of jaundice, such as yellowing of the skin and whites of the eyes.
Several blood tests may be used to test for hepatitis C. The first blood test is antibody testing for hepatitis C. (The body makes antibodies in response to an infectious substance, such as a virus.)
If antibodies are found, that means that the person was exposed to hepatitis C at some point. A blood test called a PCR RNA can determine if the blood is still infected with the active virus. If the result is positive, it means that the person is currently infected with hepatitis C. If the PCR RNA is negative but the antibody testing was positive, this means that the patient has been exposed to the virus in the past but currently does not have an active infection.
A person who has hepatitis C may have to have a liver biopsy or a liver fibrosis scan (also known as a fibroscan) to tell if the liver is damaged, and how much damage has occurred.
You should be referred to a specialist who has experience in treating hepatitis C as soon as you are diagnosed with active (chronic) hepatitis C infection.
Management and Treatment
How is hepatitis C treated?
There is no vaccine for hepatitis C. The aim of treatment for hepatitis C is to eradicate the virus from the blood completely, and to protect the liver from developing cirrhosis or liver cancer.
Several medications are available to treat hepatitis C. The hepatitis C virus has six different types or strains (also known as genotypes). The type and length of treatment may vary. Some hepatitis strains do not respond to antiviral medications as well as others. Some medications may not be suitable for all patients with hepatitis C, because of the side effects or the patient’s other medical conditions.
These are the medications approved for treatment of hepatitis C infection:
- Sofosbuvir (Sovaldi®): Tablet taken once a day. Used in combination with other antiviral drugs.
- Ledipasvir/sofosbuvir (Harvoni®): Pill taken once a day for 12 to 24 weeks, depending on how serious the disease is.
- Simeprevir (Olysio®): Capsule taken once a day with other medications called peginterferon alfa and ribavirin
- Combination of paritaprevir/ombitasvir/ritonavir/dasabuvir (Viekira Pak®)
- Daclatasvir (Daklinza®): Used in combination with other drugs
- Elbasvir/grazoprevir (Zepatier®): Tablet taken once a day
- Sofosbuvir/velpatasvir (Epclusa®): Tablet taken once a day
- Glecaprevir/pibrentasvir (Mavyret®): Three pills a day in one dose
- Sofosbuvir/velpatasvir/voxilaprevir (Vosevi®): Tablet taken once a day
- Ombitasvir/paritaprevir/ritonavir (Technivie®): Two tablets once a day in the morning, in combination with ribavirin
IMPORTANT: Ribavirin may cause birth defects. Both men and women taking Ribavirin MUST use two forms of birth control during therapy and for up to six months after stopping therapy. Patients should be monitored by their doctors when using these drugs.
Can hepatitis C be prevented?
There is no vaccine against hepatitis C. The only way to prevent infection is to avoid contact with infected blood.
Hepatitis C cannot be spread by coughing, sneezing or sharing eating utensils. People should not be kept away from school, work, or other social settings because they have hepatitis C.
Here are some precautions that may prevent the spread of hepatitis C:
- Do not share personal care items, such as toothbrushes or razors, with others.
- Practice safe sex by using condoms.
- Don’t share needles or syringes.
- Wear gloves when handling another person’s blood.
- Use sterile equipment for body piercings or tattoos.
- If you are a healthcare worker, follow recommended safety measures.
People who are at greater risk for contracting hepatitis C should have their blood tested. The Centers for Disease Control recommends that Americans born between 1945 and 1965 be screened at least once for the disease.
Outlook / Prognosis
What is the prognosis (outlook) for someone who has hepatitis C?
You can continue to lead an active life even if you are diagnosed with hepatitis C. People with the disease can work and continue their regular daily activities. However, it is very important that you see a specialist as soon as you are diagnosed with hepatitis C. There are many treatments available that can cure the virus.
To maintain a healthy lifestyle, patients should:
- Exercise regularly
- Eat balanced, nutritious meals
- Limit how much alcohol they drink or abstain completely (depending on the extent of liver damage from the virus; check with your doctor).
- Check with a doctor before taking over-the-counter medications, such as acetaminophen (Tylenol®) or any other medications.
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