Few people develop noticeable symptoms of this often slowly progressing liver disease. Those who do might display theses signs.

By Karen Pallarito
Updated March 05, 2019

Would you know if hepatitis C were setting up shop in your liver? Most people with this blood-borne infection haven’t a clue. Hepatitis C symptoms are often vague or non-existent. Sometimes symptoms surface only years down the road, after the liver has taken a beating.

It’s possible you might develop mild, flu-like symptoms the first time you’re exposed to hepatitis C. But most “acute,” or recently acquired, infections go undetected, doctors say. Experts say roughly 20% of people who are infected clear the virus from their bodies without treatment. But most people go on to develop a chronic infection.

Hepatitis C can live quietly in a person’s body for many, many years. “But it’s not doing nothing—it’s replicating,” says Amy Jessop, PhD, director of the Hepatitis Training, Research, and Education Center (HepTREC) in Philadelphia.

Doctors have no way of predicting whose disease will remain asymptomatic and whose will provoke mild-to-severe symptoms, says Aaron Glatt, MD, an Infectious Diseases Society of America (IDSA) spokesperson and chairman of the Department of Medicine at South Nassau Communities Hospital in Oceanside, New York.

The most onerous hep C symptoms usually signal impaired liver function or scarring of the liver (known as cirrhosis), but the absence of symptoms doesn’t mean you’re out of the woods. “A lot of patients are asymptomatic even though they have significant long-term illness,” Dr. Glatt says.

That’s why experts say you should never wait for symptoms to appear. If you think you may have been exposed to the hep C virus, talk to your doctor about getting tested.

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Fever

Someone newly infected with hepatitis C may develop a mild fever. But most people do not have a strong immediate reaction to the virus, notes Jessop, who is also an associate professor of public health at Western Michigan University in Kalamazoo.

Low-grade fever can also be a symptom of chronic infection, according to the American Academy of Family Physicians.

Fatigue

Initially, you might feel tired as your body tries to fight the virus. If the infection becomes chronic, you might have periods of fatigue or just a general feeling of being wiped out.

“It’s kind of there all the time at low levels,” Jessop says.

Blaire E. Burman, MD, director of the hepatitis C treatment clinic at Virginia Mason Medical Center in Seattle, says her female patients tend to report fatigue more often than men.

RELATED: 14 Reasons You’re Always Tired

Joint pain

Sore joints? It’s not uncommon with hepatitis C. Studies suggest the achiness, which can affect either the small or large joints, is a consequence of the body’s normal infection-fighting process.

“People notice it in the hands and wrists,” Dr. Burman says.

Abdominal pain

The liver doesn’t have nerve endings that can sense pain, but the capsule of connective tissue surrounding the liver does, Dr. Burman explains.

With acute hepatitis C infection, sudden liver inflammation can stretch that outer layer of tissue, causing pain in the upper right part of the abdomen, she says.

“You should not have abdominal pain with chronic hep C,” she adds.

Loss of appetite

When you’re sick with a viral infection, you don’t really have much of an appetite. Same with hepatitis C.

Loss of appetite can be a symptom of both acute and chronic Hep C.

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Nausea and vomiting

Nausea and vomiting are among the non-specific symptoms of acute and chronic hepatitis C.

When your liver isn’t working well, that’s when more severe symptoms, like vomiting, typically occur, Jessop says.

Yellow skin or eyes

When your body breaks down old red blood cells, it forms a yellow-orange pigment called bilirubin. Excess bilirubin in the blood causes jaundice, a yellowing of the skin or the whites of the eyes.

Hepatitis, including acute and chronic hep C, is one of the common causes of jaundice.

“If anybody thinks they have jaundice, they should get to the doctor right away, because it’s a sign that your liver’s having trouble,” Jessop says. Skin symptoms may be less noticeable in someone who is dark-skinned, she adds.

RELATED: 8 Things You Probably Didn’t Know About Hepatitis

Pale stools

Normally, bilirubin binds with bile in the liver and gets excreted. It’s a large part of what gives your stool its dark brown color.

But if you have a liver problem such as hepatitis C, you might have pale or clay-colored stools.

Dark urine

High levels of bilirubin excreted in urine is another sign of jaundice. Instead of yellow or straw-colored pee, it could be as dark as cola.

Dark urine alone doesn’t necessarily mean you have a hepatitis C infection, though. “There are many other things that can cause a darker urine,” including dehydration, Dr. Glatt says.

RELATED: What Your Pee Color Says About Your Health

Swollen belly

Technically, it’s called ascites—an abnormal buildup of fluid in the abdomen. A large belly can be a complication of long-term, untreated chronic hepatitis C.

Here’s what happens: Severe liver scarring puts pressure on the blood vessels supplying the liver with blood, causing fluid to leak from the vessels and pool in the abdomen.

Depression

If you’re living with chronic hepatitis C, you might be more likely to experience depression compared with the population in general.

Dr. Burman says it could be due to the physical toll of fighting a chronic viral infection. Or the fatigue and malaise that accompany it. Or even the stigma of the disease. The exact relationship remains unclear.

RELATED: 10 Health Conditions That Are Linked to Depression

Brain fog

People with hepatitis C often report difficulties with attention, concentration, and recall. In other words, they feel “a little brain-foggy,” as Jessop describes it.

Researchers have proposed several possible causes of cognitive impairments in chronic hep C. It might be that the virus directly impacts the brain, for example, or it could be a secondary effect of the infection-fighting process.

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