Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). It is the most common blood-borne viral infection in the United States.
Around 2.4 million people in the United States are living with a diagnosis of hepatitis C. However, many people with the infection do not know that they have it.
The hepatitis C virus (HCV) causes hepatitis C. It is contagious, and a person can transmit it to someone else through blood-to-blood contact.
The main complication of chronic hepatitis C is liver damage. This can include cirrhosis, liver failure, and liver cancer. Early diagnosis can prevent liver damage. Left untreated, hepatitis C can be fatal.
New medications can cure chronic hepatitis C, and some researchers believe the infection could become rare in the U.S. by the year 2036. There is no vaccine to prevent hepatitis C, but people can take steps to reduce their risk of infection.
This article provides an overview of acute and chronic hepatitis C, including their symptoms, causes, and treatments.
These viruses invade liver cells, causing swelling and dysfunction. Over time, inflammation in the liver tissue can damage the organ.
Hepatitis C infections can be acute (short-term) or chronic (long-lasting). When a person has acute hepatitis, symptoms can last for 6 months.
An acute infection becomes chronic if the body cannot clear the virus. This is common — acute infections become chronic in more than 50% of cases.
According to the Centers for Disease Control and Prevention (CDC), today, most new cases of hepatitis C occur from contact with needles or other equipment used to prepare or inject drugs. This is often from sharing needles or accidental contact in healthcare settings.
Hepatitis C can range from a mild illness that lasts for a few weeks to a severe and chronic health condition.
People can have hepatitis C with no symptoms, especially at the acute stage, and may not know they have it. This makes it easier to transmit to others.
Acute hepatitis C
Most people with acute hepatitis C do not develop symptoms. If they do, symptoms usually arise between 2 and 12 weeks after exposure.
People rarely receive a diagnosis of acute hepatitis C as it lacks definitive symptoms. Because of this, doctors often call hepatitis C the silent epidemic.
The acute symptoms are very similar to other viral infections. Symptoms of acute hepatitis C include:
- a fever
- abdominal pain
- loss of appetite
- nausea or vomiting
- dark urine
- clay-colored stool
- joint pain
- jaundice, rarely
According to CDC, less than half of people with acute hepatitis C clear the virus from their bodies without treatment and do not develop the chronic condition. Researchers do not know why this happens in some people and not others.
Chronic hepatitis C
Hepatitis C becomes chronic when the body cannot clear the virus.
In most cases, chronic hepatitis C does not cause any symptoms or causes general symptoms, such as chronic fatigue or depression. A person may only find out they have the condition during a routine blood test or screening for a blood donation.
Early diagnosis and treatment can prevent liver damage. Left untreated, chronic hepatitis C can lead to:
- chronic liver disease, which can happen slowly over several decades without any symptoms
- cirrhosis, or liver scarring, which occurs in up to 20% of people after 20–30 years
- liver failure
- liver cancer
THe HCV virus causes hepatitis C.
People contract the virus through blood-to-blood contact with contaminated blood. For transmission to occur, blood containing HCV must enter the body of a person without HCV.
A speck of blood, invisible to the naked eye, can carry hundreds of hepatitis C virus particles. The virus is not easy to kill.
The CDC offers advice on cleaning syringes if it is not possible to use clean and sterile ones. Although bleach might kill the HCV in syringes, it may not have the same effect on other equipment. Boiling, burning, and using alcohol, peroxide, or other common cleaning fluids to wash equipment may reduce the amount of HCV, but it might not stop a person contracting the infection.
It is extremely dangerous to inject bleach, disinfectant, or other cleaning products, so be sure to rinse the syringe thoroughly. Only ever use bleach to clean equipment if new, sterile syringes and equipment are not available.
A person cannot contract the virus from casual contact, breathing, kissing, or sharing food. There is no evidence that mosquito bites can transfer the virus.
The CDC report the following risk factors for developing hepatitis C:
- using or having used injectable drugs, which is currently the most common route in the U.S.
- receiving transfusions or organ transplants before 1992, which is before blood screening became available
- exposure to a needle stick, which is most common in people who work in healthcare
- being born to a mother who has hepatitis C
Though the risk is low, people can also contract hepatitis C through:
- sexual contact without barrier protection, especially rough or anal sex, which makes blood-to-blood contact more likely
- sharing items that could have contact with blood, such as toothbrushes or razors
- invasive healthcare procedures, such as injections
- unregulated tattooing
People who are at risk due to these factors can receive a screening to rule out HCV.
Doctors can diagnose hepatitis C using blood tests:
- First, the doctor will perform a simple blood test to look for hepatitis C antibodies in the blood. A positive test means that the person has had exposure to the virus, but does not necessarily prove ongoing infection.
- If the antibody test is positive, the person may then have a second blood test called a hepatitis C RNA test. This will check whether the virus is still present in the blood.
- A third blood test — called a genotype test — can work out which type of hepatitis C virus is present, as there are at least six types.
If the person has had hepatitis C for a long time, a doctor may recommend further tests to look for liver damage, measure the severity of any existing damage, and rule out other causes of damage.
These tests usually involve blood tests and ultrasound scans. Doctors only use a liver biopsy — which involves taking a small sample of liver tissue — when the other tests do not provide enough information.
Modern treatments can cure hepatitis C in most cases. These treatments involve a combination of antiviral medications taken for 8 to 24 weeks.
Direct-acting antiviral medicines (DAAs) can cure most cases of chronic hepatitis C and acute hepatitis C. These are modern medicines approved in 2013. The medications are well-tolerated, with the most common side effects being a headache and fatigue.
These medications work by targeting specific steps in the HCV life cycle to disrupt the reproduction of viral cells.
DAAs to treat hepatitis C include:
- elbasvir/grazoprevir (Zepatier)
- glecaprevir and pibrentasvir (Mavyret)
- peginterferon alfa-2a (Pegasys)
- sofosbuvir (Sovaldi)
The choice of medication and duration of treatment depends on the genotype of the virus. Genotype 1a is the most prevalent in the U.S.
Before DAAs became available, the treatment for chronic hepatitis C was lengthy and uncomfortable, with less than ideal cure rates. Now, the cure rates are over 90%.
However, new medications can be very costly. Most government and private health insurance prescription drug plans will help provide some coverage for these medications. Some drug companies and other programs can help, too.
Speak with a healthcare professional for advice on paying for hepatitis C treatment.
It is important to note that a person can get hepatitis C more than once. After successful treatment, the person should take steps to prevent another infection.
People can get vaccines to prevent hepatitis A and hepatitis B, but there is currently no vaccine for hepatitis C. To prevent infection, people must avoid exposure to the virus that causes it.
According to the CDC, the best way to prevent hepatitis C is to stop injecting. Using drug treatments such as methadone or buprenorphine reduce the risk because they do not involve injections.
If a person continues to inject, they can reduce their risk of hepatitis C by using a new needle each time they inject, never sharing needles with another person, and making sure the environment, injection site, and all equipment are clean and sterilized before injecting.
Obesity, smoking, diabetes, and alcohol consumption can accelerate the rate of liver scarring. It is important that all individuals with hepatitis C maintain good health. This involves:
- quitting smoking
- maintaining a healthy weight
- managing other health problems
- avoiding alcohol
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recommend that people who have hepatitis C use the following methods to prevent transmitting it to others:
- avoiding sharing drug needles or other drug materials
- wearing gloves when touching another person’s open sores
- telling any tattooists or piercer that you have hepatitis C and making sure they use sterile tools and unopened ink
- avoiding sharing items such as toothbrushes, razors, and nail clippers
- telling any new sexual partners that you have hepatitis C and using barrier protection during sexual activity
Hepatitis C is the most common blood-borne viral infection in the U.S. and can cause fatal liver damage if left untreated. In 2016, the CDC reported at least 18,153 deaths related to hepatitis C.
However, improvements in education, risk-based screening, prevention methods, and modern treatments, the outlook for hepatitis C is better than ever.
Early diagnosis and treatment can significantly improve a person’s outlook and prevent liver damage. Modern medicines can cure hepatitis C in 90% of cases.
These treatments are expensive. If a person is at risk of exposure to the virus, they should have regular screenings to make sure they do not have the virus. Following prevention strategies correctly, can usually help a person avoid contracting the virus.