Hepatitis C and the Hep C Virus

What Is Hepatitis C?

Hepatitis C is a liver infection that can lead to serious liver damage. It’s caused by the hepatitis C virus. About 3.9 million people in the U.S. have the disease. But it causes few symptoms, so most of them don’t know. The virus spreads through an infected person’s blood or body fluids.

There are many forms of the hepatitis C virus, or HCV. The most common in the U.S. is type 1. None is more serious than any other, but they respond differently to treatment.

Stages of Hepatitis C

The hepatitis C virus affects people in different ways and has several stages:

  • Incubation period. This is the time between first exposure to the start of the disease. It can last anywhere from 14 to 80 days, but the average is 45
  • Acute hepatitis C. This is a short-term illness that lasts for the first 6 months after the virus enters your body. After that, some people who have it will get rid of, or clear, the virus on their own.
  • Chronic hepatitis C. For most people who get hepatitis C — up to 85% — the illness moves into a long-lasting stage (longer than 6 months). This is called a chronic hepatitis C infection and can lead to serious health problems like liver cancer or cirrhosis.
  • Cirrhosis. This disease leads to inflammation that, over time, replaces your healthy liver cells with scar tissue. It usually takes about 20 to 30 years for this to happen, though it can be faster if you drink alcohol or have HIV.
  • Liver cancer. Cirrhosis makes liver cancer more likely. Your doctor will make sure you get regular tests because there are usually no symptoms in the early stages.

Learn more about the stages and progression of hepatitis C.

What Are the Symptoms of Hepatitis C?

Many people with hepatitis C have no symptoms. But between 2 weeks and 6 months after the virus enters your bloodstream, you could notice:

  • Clay-colored poop
  • Dark urine
  • Fever
  • Fatigue
  • Jaundice (a condition that causes yellow eyes and skin, as well as dark urine)
  • Joint pain
  • Loss of appetite
  • Nausea
  • Stomach pain
  • Vomiting

Symptoms usually last for 2 to 12 weeks. Read more on the symptoms and early warning signs of hepatitis C.

How Do You Get Hepatitis C?

Hepatitis C spreads when blood or body fluids contaminated with the hepatitis C virus get into your bloodstream through contact with an infected person.

You can be exposed to the virus from:

  • Sharing injection drugs and needles
  • Having sex, especially if you have HIV, another STD, several partners, or have rough sex
  • Being stuck by infected needles
  • Birth — a mother can pass it to a child
  • Sharing personal care items like toothbrushes, razor blades, and nail clippers
  • Getting a tattoo or piercing with unclean equipment

You can’t catch hepatitis C through:

  • Breastfeeding (unless nipples are cracked and bleeding)
  • Casual contact
  • Coughing
  • Hugging
  • Holding hands
  • Kissing
  • Mosquito bites
  • Sharing eating utensils
  • Sharing food or drink
  • Sneezing

Symptoms of Advanced Hepatitis C

You could notice acute symptoms along with:

  • Fluid buildup in the abdominal cavity (ascites) or the legs (edema)
  • Gallstones
  • Your brain doesn’t work as well (encephalopathy)
  • Kidney failure
  • Easy bleeding and bruising
  • Intense itching
  • Muscle loss
  • Problems with memory and concentration
  • Spider-like veins on the skin
  • Vomiting blood due to bleeding in the lower esophagus (esophageal varices)
  • Weight loss

Hepatitis C Risk Factors

The CDC recommends you get tested for the disease if you:

  • Received blood from a donor who had the disease
  • Have ever injected or inhaled drugs
  • Had a blood transfusion or an organ transplant before July 1992
  • Received a blood product used to treat clotting problems before 1987
  • Were born between 1945 and 1965, the age group with the highest rate of infection
  • Have been on long-term kidney dialysis
  • Have HIV
  • Were born to a mother with hepatitis C
  • Have symptoms of liver disease
  • Got a tattoo or piercing with unclean equipment
  • Have ever been in prison

Since July 1992, all blood and organ donations in the U.S. are tested for the hepatitis C virus. The CDC says it is now rare that someone getting blood products or an organ would get hepatitis C. That said, The CDC recommends that anyone over the age of 18 get tested for Hepatitis C. If you haven’t been screened, you should consider having it done.

Learn more about the risk factors for hepatitis C.

Hepatitis C Testing and Diagnosis

Doctors will start by checking your blood for:

Anti-HCV antibodies: These are proteins your body makes when it finds the hep C virus in your blood. They usually show up about 12 weeks after infection.

It usually takes a few days to a week to get results, though a rapid test is available in some places.

The results can be:

  • Nonreactive, or negative:
    • That may mean you don’t have hep C.
    • If you’ve been exposed in the last 6 months, you’ll need to be retested.
  • Reactive, or positive:
    • That means you have hep C antibodies and you’ve been infected at some point.
    • You’ll need another test to make sure.

If your antibody test is positive, you’ll get this test:

HCV RNA: It measures the number of viral RNA (genetic material from the hepatitis virus) particles in your blood. They usually show up 1-2 weeks after you’re infected.

  • The results can be:
    • Negative: You don’t have hep C.
    • Positive: You currently have hep C.

You might also get:

Liver function tests: They measure proteins and enzyme levels, which usually rise 7 to 8 weeks after you’re infected. As your liver gets damaged, enzymes leak into your bloodstream. But you can have normal enzyme levels and still have hepatitis C. Learn the reasons why you should get tested for hepatitis C.

Treatment and Medication for Hepatitis C

If you have acute hepatitis C, there is no recommended treatment. If your hepatitis C turns into a chronic hepatitis C infection, there are several medications available.

Interferon, peginterferon, and ribavirin used to be the main treatments for hepatitis C. They can have side effects like fatigue, flu-like symptoms, anemia, skin rash, mild anxiety, depression, nausea, and diarrhea.

Now you’re more likely to get one of these medications:

  • Daclatasvir (Daklinza). You’ll take this pill once a day along with sofosbuvir for 12 weeks.
  • Elbasvir-grazoprevir (Zepatier). This once-daily pill has cured the disease in as many as 97% of those treated.
  • Glecaprevir-pibrentasvir (Mavyret). This daily pill offers a shorter treatment cycle of 8 weeks for adult patients with all types of HCV who don’t have cirrhosis and who haven’t already been treated. The treatment is longer for those who are in a different disease stage. The prescribed dosage for this medicine is 3 tablets daily.
  • Ledipasvir-sofosbuvir (Harvoni). This once-daily pill cures the disease in most people in 8-12 weeks.
  • Ombitasvir-paritaprevir-dasabuvir-ritonavir (Viekira Pak). This treatment is a combo of pills: two that you’ll take once a day, and one you’ll take twice with meals. You’ll take it for 12 to 24 weeks.
  • Ombitasvir-paritaprevir-ritonavir (Technivie).  You’ll take this tablet by mouth, possibly along with ribavirin.
  • Ribavirin (Copegus, Moderiba, Rebetol, Ribasphere, Virazole). This comes as a tablet, capsule, or liquid. You take it with food twice a day, in the morning and evening, for 24 to 48 weeks or longer.
  • Sofosbuvir (Sovaldi) with interferon and ribavirin. Take this tablet at the same time every day with food. You have to take it along with ribavirin and/or interferon, and you’ll probably be on it for 12 to 24 weeks.
  • Sofosbuvir-velpatasvir (Epclusa). This daily pill, which you take for 12 weeks, should cure your disease.
  • Sofosbuvir-velpatasvir-voxilaprevir (Vosevi). This combination is approved to treat adults with chronic HCV, either with no cirrhosis or with compensated cirrhosis (the stage of the disease that doesn’t have symptoms), who’ve already had certain treatments.

Find out more on treatment options for hepatitis C.

What Are the Side Effects of Hepatitis C Medications?

The most common side effects of hepatitis C drugs depend on the medicine and often include:

  • Flu-like symptoms
  • Fatigue
  • Hair loss
  • Headache
  • Low blood counts
  • Trouble thinking
  • Nervousness
  • Depression

What Are the Complications of Hepatitis C?

About 75% to 85% of people who have it get a long-term infection called chronic hepatitis C. If the condition goes untreated, it can lead to:

  • Cirrhosis, or scarring of the liver
  • Liver cancer
  • Liver failure

Read more on complications of hepatitis C.

Questions for Your Doctor

When you visit the doctor, you may want to ask questions to get the information you need to manage your hepatitis C. If you can, have a family member or friend take notes. You might ask:

  1. What kinds of tests will I need?
  2. Are there any medications that might help?
  3. What are the side effects of the medications you might prescribe?
  4. How do I know when I should call the doctor?
  5. How much exercise can I get, and is it all right to have sex?
  6. Which drugs should I avoid?
  7. What can I do to prevent the disease from getting worse?
  8. How can I avoid spreading hepatitis C to others?
  9. Are my family members at risk for hepatitis C?
  10. Should I be vaccinated against other types of hepatitis?
  11. How will you keep tabs on the condition of my liver?

Can You Prevent Hepatitis C Infection?

There’s no vaccine to prevent hepatitis C. To avoid getting the virus:

  • Use a latex condom every time you have sex.
  • Don’t share personal items like razors.
  • Don’t share needles, syringes, or other equipment when injecting drugs.
  • Be careful if you get a tattoo, body piercing, or manicure. The equipment may have someone else’s blood on it.

Find out more on how to prevent hepatitis C.

What’s Your Outlook?

Today, the outlook for most people with hepatitis C who are treated is good. With new treatments, the viral cure rate is above 90%. The goal of antiviral medications is a condition called sustained virologic response. The hepatitis virus is considered to be “cured” if no virus shows up in a blood test that is done 3 months after your treatment ends.

After treatment, make sure you stick with the healthy habits your doctor has instructed and follow up with them regularly. People in whom the virus has not been successfully treated may go on to get cirrhosis and liver disease may need a liver transplant.