Hepatitis C

What is hepatitis C?

Hepatitis C is a viral infection that causes inflammation that damages your liver. You can get the infection if you have exposure to the hepatitis C virus (HCV) after contact with blood that carries the virus. Hepatitis C can cause acute or chronic infections:

• Acute hepatitis C: This is a short-term infection. The infection may not cause symptoms. If it does, it may take up to six months for your body to fight off the infection and make the virus go away.
• Chronic (long-term) hepatitis C: This happens when your body can’t fight off the infection. You have the virus, but it doesn’t cause symptoms, or your symptoms are mild. About 20% to 30% of people with chronic hepatitis C develop cirrhosis. Cirrhosis can lead to liver cancer or liver failure.

Researchers estimate between 2 and 4 million people in the U.S. have chronic hepatitis C. Many of them don’t know they have it. That’s why healthcare providers in the U.S. recommend everyone age 18 and older has a screening test for the virus. Tests to screen for hepatitis C let providers diagnose and treat it before the virus damages your liver. Treatment can cure hepatitis C.

What are the symptoms of hepatitis C?

Most people don’t have any symptoms. People with acute hepatitis C may feel like they’re coming down with flu. They may have the following symptoms:

• Abdominal pain
• Body aches
• Dark-colored pee (urine)
• Fatigue
• Fever
• Gray- or clay-colored poop (stool)
• Jaundice
• Joint pain
• Loss of appetite
• Nausea and vomiting

Chronic hepatitis C symptoms happen over months and, sometimes, years. Often, the first symptoms you may notice are symptoms of cirrhosis like:

• Confusion and changes in behavior and mood from hepatic encephalopathy
• Excessive bleeding (hemorrhage)
• Jaundice
• Pain in your upper left abdomen (belly)
• Reddish or dark-colored skin on your palms
• Small, spiderlike blood vessels in your skin (spider angiomas)
• Swollen belly and unexplained weight gain from ascites (fluid buildup in your belly)
• Vomiting blood because swollen veins in your esophagus (esophageal varices) cause bleeding in your digestive tract

How do you get hepatitis C?

You get hepatitis C if you have contact with blood from someone who has the virus. In the U.S., sharing needles to inject intravenous drugs is the most common way that the virus spreads. But you may have an increased risk for exposure if you have or had:

• A blood transfusion or organ transplant before July 1992
• Dialysis
• Exposure to blood or infected needles at work
• HIV
• Tattoos or body piercings with unsterilized equipment

You may also have an increased risk for hepatitis C if you:

• Share a razor or toothbrush with someone who has the virus and may bleed on a shared razor or toothbrush
• Have sex with someone who has the virus, especially if that person has HIV
• Were born to a woman who has the virus

What are the complications of hepatitis C?

Cirrhosis is the most common complication. Cirrhosis may lead to serious diseases like:

• Liver failure
• Liver cancer

How do healthcare providers diagnose hepatitis C?

A healthcare provider will ask about your symptoms. They’ll ask if you’ve had blood transfusions or use injectable drugs. They’ll do a physical examination to look for signs of liver damage like:

• Changes in your skin color and the whites of your eyes (sclera).
• Swelling in your lower legs, ankles or feet.
• Tenderness or swelling in your abdomen.

They may order blood tests, including:

• Hepatitis C antibody test: This shows whether your blood contains antibodies to the virus.
• Hepatitis C RNA test: This test shows if the virus is still active.
• Genotype test: There are at least six strains or genotypes of hepatitis C. This test shows which strain you have. Your provider will use test results to recommend treatment.
• Liver function test: This test checks on your liver’s overall health.
• Transient elastography: This is an ultrasound of your liver. It measures the amount of fibrosis or stiffness in your liver.

How is hepatitis C treated?

The most common treatment for chronic hepatitis C is direct-acting antiviral (DAA) medication. DAAs reduce the amount of virus in your body. DAAs commonly used for initial treatment include:

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

DAAs are tablets that you swallow. Most people take the tablets for two to six months. Research shows these medications cure most cases of chronic hepatitis C.

What are treatment side effects?

Common DAA side effects include:

• Abdominal pain.
• Diarrhea.
• Fatigue.
• Headache.
• Nausea and vomiting.
• Shortness of breath (dyspnea).

Can your liver heal from hepatitis C?

Yes, it can. About 25% of people with acute hepatitis C recover completely, meaning the virus goes away. And treatment can cure chronic hepatitis C if you receive a diagnosis and treatment before the infection causes serious liver damage.

Can hepatitis C be prevented?

The only way to prevent hepatitis C infection is to avoid contact with infected blood. In particular, you shouldn’t share needles or syringes.

Is there a vaccine for hepatitis C?

No, but researchers continue to work on a vaccine. The virus has many variations and mutates very quickly. That makes it challenging to develop a vaccine that’s effective against all variations.

What can I expect if I have hepatitis C?

Medication can cure hepatitis C. But everyone’s situation is different. For example, you may not receive a diagnosis before the virus causes severe liver damage. In that case, you may need treatment for conditions like cirrhosis or liver failure.

How do I take care of myself?

Hepatitis C can damage your liver. If you have hepatitis C, you should protect your liver from harm by:

• Cutting back or quitting drinking beverages that contain alcohol
• Quitting smoking
• Getting vaccinated against hepatitis A and B
• Asking your healthcare provider if you’ll need regular hepatitis C screening

When should I call the doctor?

Contact your healthcare provider if your symptoms get worse or you develop new symptoms. For example, liver damage from chronic hepatitis C can cause serious issues like vomiting blood. That would be a reason to call your provider.

Is hepatitis C transmitted through saliva?

No, contact with infected blood is the only way to transmit hepatitis C.

Is hepatitis C considered a sexually transmitted disease?

People rarely get hepatitis C because they have sex with someone who has the virus. But it can happen if you have contact with blood while having sex, like you have sex with someone who has cuts or sores on their genitals. It can happen if you have anal sex or any sexual activity where you or your partner bleed or have cuts or sores (broken skin).