What Is Hepatitis C?

Hepatitis is a medical term for inflammation in your liver. Several factors can cause hepatitis, including hepatitis viruses. Of the five known types of hepatitis viruses, hepatitis C virus (HCV) is the only one without a vaccine.

The hepatitis C virus can spread from person to person through infected blood. An HCV infection causes hepatitis C, which is a liver condition that can last up to six months or more. Most people who have an infection can have lifelong chronic hepatitis. However, for chronic hepatitis C, treatments are available to help manage symptoms and prevent further liver complications.

Types

Hepatitis C can vary by the strain of hepatitis C virus. Scientists have identified at least seven major strains of HCV. Each strain is a distinct variant of HCV, named genotypes 1–7. Each genotype can have different subtypes. The most common strain is genotype 1—it makes up 60–70% of hepatitis C cases in the United States. Depending on the type of strain you have, a healthcare provider will determine what medication is right for you.

Additionally, hepatitis C can either be an acute (short-term) or chronic condition (long-term).

Acute Hepatitis C

Acute hepatitis C is a short-term viral infection that develops in the initial weeks or months after the hepatitis C virus (HCV) enters a person's bloodstream. Oftentimes, you may not experience any symptoms with acute infection—which explains why hepatitis C can go underdiagnosed. In 2020, over 4,700 people in the United States were newly diagnosed with acute hepatitis C. However, the CDC also estimates that over 62,000 additional people may have had it without knowing.

Less commonly, you may experience symptoms such as nausea, fever, or upper right abdominal pain.

For about 15–20% of acute cases, an individual’s immune system may be able to fight off the virus on its own without treatment, usually within 6 months. 

Chronic Hepatitis C

An estimated 80–85% of people with acute hepatitis C go on to develop chronic infection, lasting at least six months or longer. Even at this stage, most people do not experience symptoms. Years of infection can damage the liver, and you may not realize you have hepatitis C until signs of liver dysfunction begin to surface.

Often, chronic hepatitis C is first detected when a person with HCV tries to donate blood. (Donated blood is routinely tested for hepatitis C virus and other infections.) In other cases, your healthcare provider may recommend you get tested for HCV if you have abnormal results during a routine blood test.

In 2020, over 100,000 Americans were newly diagnosed with chronic hepatitis C. Each year the number of new cases increases, and there may be over 4 million people in the U.S. who have ever had or currently have a chronic infection, based on 2013–2016 data.

Causes

Hepatitis C is caused by the hepatitis C virus, which was first discovered in 1989. You can get this virus from HCV-positive blood that enters your body. 

The virus can then invade your liver cells and make copies of itself. Your immune system will fight off some infected cells—though often, the virus replicates and changes faster than your immune cells can respond. The infection can cause fat and toxin buildup in your liver, resulting in liver inflammation. Though it’s not entirely clear why some people clear the virus on their own while others don’t, a chronic infection likely means the virus is able to persist despite the immune system trying to fight it.

Risk Factors

You are at a higher risk for hepatitis C if you:

• Use shared needles or syringes for drug injection 
• Get tattoos or body piercings with unsterilized tools
• Are accidentally exposed to infected needles, sharp medical tools, or blood, particularly if you are a healthcare worker
• Use shared personal hygiene tools, like razors
• Had sex with multiple partners
• Have anal sex, particularly unprotected anal sex
• Have HIV or other sexually transmitted infections (STIs)
• Your birthing parent had HCV when you were born (research estimates around 6% of babies born to HCV-positive birthing parents contract HCV during birth)
• Had a blood transfusion or organ transplant before July 1992 (when blood tests for HCV became standard)
• Received maintenance hemodialysis, a treatment for kidney disease
• Received clotting factor to treat hemophilia before 1987

While less common, you can get HCV from touching the open sores or cuts of someone with HCV, or from having unprotected sex with someone with HCV.

It is now very rare to get an HCV infection from a blood transfusion or organ transplant in the U.S. as blood screening became part of the standard healthcare procedure in 1992. 

Symptoms 

 The common signs and symptoms of hepatitis C vary depending on whether you have an acute infection or a chronic infection.

Most people with acute infection do not show any symptoms. However, people who experience symptoms usually do so within one to three months after exposure. These may include:

• Changes in the color of your urine and stool
• Fever and fatigue
• Joint pain
• Abdominal pain 
• Nausea and vomiting
• Loss of appetite
• Jaundice, or yellowing of the eyes and skin

 Most people with chronic infections have very few, if any symptoms. These symptoms can include:

• Depression
• Fatigue
• Disrupted sleep
• Abdominal pain
• Nausea
• Diarrhea
• Weight loss
• Joint or muscle pain

People with chronic infections are often unaware that they are HCV-positive until they begin to have more serious liver complications of hepatitis C, such as cirrhosis (severe liver scarring) or liver cancer.

Diagnosis

A healthcare provider may begin a diagnosis of hepatitis C with screening tests for HCV detection—an antibody test and an HCV RNA test. These tests will likely be followed by additional diagnostic tests to determine specific details about your condition, including the severity and strain.

Screening for Hepatitis C

The CDC recommends all adults to be screened for hepatitis C at least once in their life, especially considering that the condition can often have no symptoms and go unnoticed. If you are at increased risk for contracting HCV, you should talk to your healthcare provider about having more regular screenings. Anyone who is pregnant and plans to give birth should also get screened for hepatitis C.

 To screen for hepatitis C, your healthcare provider will take blood samples for two different tests—an antibody test and an RNA test.

Antibody Test

This test can determine whether or not you have ever had an HCV infection. If you contracted HCV at some point, your body would have made antibodies to fight off the virus and you will test positive. A negative test could mean you either have never been exposed to hepatitis C, or it is in its early stages and your body hasn’t produced antibodies yet.

HCV RNA Test

A negative result for the HCV RNA test means your body has likely already recovered. A positive result means you likely currently have HCV. In either case, your healthcare provider will follow up with additional tests. In the event that you currently have HCV, they will prescribe appropriate treatments.

Diagnosing Acute From Chronic Infection

In some cases, your healthcare provider may be able to determine whether your HCV is acute or chronic based on your screening results. For example, if you routinely get screenings and had no history of HCV in the past 6 months, then your case is likely acute.

Your provider can also repeat the RNA test about six weeks after your initial screening and compare results of your viral levels (viral load). Consistent, high levels of viral RNA may suggest that your HCV is chronic, whereas fluctuating, low levels suggest that it’s acute.

Other Diagnostic Tests

Your healthcare provider may perform the following tests to further understand your liver condition, which can help in planning your treatment regimen:

• Genotype test: This blood test can determine what genotype of HCV you have.
• Liver ultrasound: Known as a transient elastography, this non-invasive imaging test helps examine changes in your liver. 
• Liver biopsy: To determine how severe your case is, your provider can take a sample of liver tissue and check for tissue scarring (fibrosis). This test is recommended for people who are immunocompromised or have other liver conditions.

You may also receive other tests to determine whether you have other types of viral hepatitis (like hepatitis A and B), other liver diseases, or HIV. Having any of these at the same time as hepatitis C can raise your risk for liver failure. If left untreated, most cases of chronic hepatitis C can develop into cirrhosis and later, hepatocellular carcinoma (a common type of liver cancer)—both of which can be life-threatening. This is why it’s important to get screening and seek treatment if you are diagnosed.

Treatment 

The CDC recommends that everyone who has hepatitis C undergo treatment, regardless of whether their case is acute or chronic.

Your treatment plan can vary depending on your severity, but typically, the first-choice treatment is a direct-acting antiviral drug (DAA). There are several types of DAAs that are FDA-approved for treating hepatitis C. All are oral tablets or pills that can be grouped into three main drug classes: 

• NS3/4A protease inhibitors 
• NS5A polymerase inhibitors
• NS5B polymerase inhibitors

Each class of antivirals blocks a different protein in the viral replication process. These medications can slow the spread and, in most cases, help cure you of hepatitis C. These treatments can be very effective: about 90% of people with HCV who take a DAA can be cured. Some DAAs are a combination of two or more drugs and may be paired with other HCV antiviral treatments, like ribavirin.

Your healthcare provider will help you choose the best course of treatment based on several factors: whether your case is acute or chronic, the genotype of HCV you have, and whether or not your liver has severe scarring. Your medical history, such as other types of viral hepatitis or other health conditions you may have, can also influence your treatment. Typically, you may take DAAs for 8 to 12 weeks, or more, depending on your condition and treatment response.

However, it is possible that some medical insurance plans may not provide coverage for using these antivirals if your case is acute. This may keep some people from receiving early treatment for hepatitis C. Even so, your healthcare provider will continue monitoring you with RNA tests and prescribe DAAs if your case doesn’t clear spontaneously and becomes chronic.

Prevention

Currently, there is no vaccine for hepatitis C, unlike other hepatitis-causing viruses. Scientists are trying to develop an effective vaccine for HCV, but a major hurdle is that the virus can develop new strains and subtypes.

To prevent getting hepatitis C, you can still take protective steps to reduce your chances of spreading or becoming exposed to HCV-positive blood.

• Get tested for HCV, especially if you have any of the risk factors listed above
• Don't use injectable drugs or, if you do, don't share needles or drug paraphernalia with other people.
• Follow the correct safety protocols if you handle needles, sharps, blood, or other bodily fluids.
• Use a condom during sex, especially if you or your partner have not been tested for HCV. 
• Ask about sterilization procedures at tattoo and piercing salons to ensure cross-contamination isn't possible.
• Avoid sharing medical or personal hygiene items with other people unless you know for certain they are not HCV-positive.

If you have hepatitis C, it's also important to avoid spreading it to other people. Always inform your sexual partners and healthcare providers about your status. Refrain from any donations of blood, semen or eggs, organs, and tissue.

To prevent worsening your condition, you can take care of your liver health and overall well-being, even as you’re taking treatments for hepatitis C. The CDC recommends that you stay physically active, follow a healthy diet, avoid drinking alcohol, and get vaccinated for hepatitis A and B viruses if needed. Talk with your healthcare provider about any other over-the-counter medications, prescription drugs, and supplements you are taking. 

A Quick Review

Hepatitis C is an inflammatory liver condition. It is caused by the hepatitis C virus (HCV) and can spread from person to person through blood exposure. This condition may resolve within 6  months if it is acute; or it can last longer, as a chronic condition. Although some symptoms may include fever, abdominal pain, nausea, and more, it is common for most people with hepatitis C to not experience any noticeable symptoms. Talk to your healthcare provider about getting screened for HCV, especially if you are at higher risk of contracting the virus. They can provide a diagnosis, treatment plan, and ways to prevent further liver complications.