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Hepatitis C

Topic Overview

The digestive system

What is hepatitis C?

Hepatitis C is a disease caused by a virus that infects the liver. In time, it can lead to cirrhosis, liver cancer, and liver failure.

Many people don't know that they have hepatitis C until they already have some liver damage. This can take many years. Some people who get hepatitis C have it for a short time and then get better. This is called acute hepatitis C. But most people who are infected with the virus go on to develop long-term, or chronic, hepatitis C.

Although hepatitis C can be very serious, most people can manage the disease and lead active, full lives.

What causes hepatitis C infection?

Hepatitis C is caused by the hepatitis C virus. It is spread by contact with an infected person's blood.

You can get hepatitis C if:

  • You share needles and other equipment used to inject illegal drugs. This is the most common way to get hepatitis C in the United States.
  • You had a blood transfusion or organ transplant before 1992. As of 1992 in the United States, all donated blood and organs are screened for hepatitis C.
  • You get a shot with a needle that has infected blood on it. This happens in some developing countries where they use needles more than once when giving shots.
  • You get a tattoo or a piercing with a needle that has infected blood on it. This can happen if equipment isn't cleaned properly after it is used.

In rare cases, a mother with hepatitis C spreads the virus to her baby at birth, or a health care worker is accidentally exposed to blood that is infected with hepatitis C.

The risk of getting hepatitis C through sexual contact is very small.footnote 1 The risk is higher if you have many sex partners.

You cannot get hepatitis C from casual contact such as hugging, kissing, sneezing, coughing, or sharing food or drink.

What are the symptoms?

Most people have no symptoms when they are first infected with the hepatitis C virus. If you do develop symptoms, they may include:

  • Feeling very tired.
  • Joint pain.
  • Belly pain.
  • Itchy skin.
  • Sore muscles.
  • Dark urine.
  • Yellowish eyes and skin (jaundice). Jaundice usually appears only after other symptoms have started to go away.

Most people go on to develop chronic hepatitis C but still don't have symptoms. This makes it common for people to have hepatitis C for 15 years or longer before it is diagnosed.

How is hepatitis C diagnosed?

Many people find out by accident that they have the virus. They find out when their blood is tested before a blood donation or as part of a routine checkup. Often people with hepatitis C have high levels of liver enzymes in their blood.

If your doctor thinks you may have hepatitis C, he or she will talk to you about having a blood test. If the test shows hepatitis C antibodies, then you have had hepatitis C at some point. A second test can tell if you still have hepatitis C.

When blood tests show that you have hepatitis C, you may need a liver biopsy to see how well your liver is working. During a liver biopsy, a doctor will insert a needle between your ribs to collect a small sample of liver tissue to look at under a microscope. You may also have imaging tests, such as a CT scan, MRI, or ultrasound, to make sure that you don't have liver cancer.

Some people prefer to find out on their own if they have been exposed to hepatitis C. You can buy a home test called a Home Access Hepatitis C Check kit at most drugstores. If the test shows that you have been exposed to the virus in the past, be sure to talk to your doctor to find out if you have the virus now.

How is it treated?

Experts recommend that nearly everyone who has hepatitis C receive treatment. Talk with your doctor about whether you should get treatment.

Newer medicines almost always work to treat hepatitis C. But they have side effects, and they cost a lot.

Taking care of yourself is an important part of the treatment for hepatitis C. Some people with hepatitis C don't notice a change in the way they feel. Others feel tired, sick, or depressed. You may feel better if you exercise and eat healthy foods. To help prevent further liver damage, avoid alcohol and illegal drugs and certain medicines that can be hard on your liver.

Health Tools

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Decision Points focus on key medical care decisions that are important to many health problems.

Cause

Hepatitis C is a liver disease that is caused by infection with the hepatitis C virus, a virus that lives in your liver cells.

How it spreads

You cannot get hepatitis C from casual contact such as hugging, kissing, sneezing, coughing, or sharing food or water with someone. You can get hepatitis C if you come into contact with the blood of someone who has hepatitis C.

The most common way to get hepatitis C is by sharing needles and other equipment (such as cotton, spoons, and water) used to inject illegal drugs.

Before 1992, people could get hepatitis C through blood transfusions and organ transplants. Since 1992, all donated blood and organs are screened for hepatitis C, so it is now rare to get the virus this way.

In rare cases, a mother with hepatitis C spreads the virus to her baby at birth, or a health care worker is accidentally exposed to blood that is infected with hepatitis C.

The risk of getting hepatitis C through sexual contact is very small.footnote 2 The risk is higher if you have many sex partners.

If you live with someone who has hepatitis C or you know someone who has hepatitis C, you generally don't need to worry about getting the disease from that person. You can help protect yourself by not sharing anything that may have blood on it, such as razors, toothbrushes, and nail clippers.

Symptoms

Most people who are infected with hepatitis C-even people who have been infected for a while-usually don't have symptoms.

If symptoms do develop, they may include:

  • Fatigue.
  • Joint pain.
  • Belly pain.
  • Itchy skin.
  • Sore muscles.
  • Dark urine.
  • Jaundice, a condition in which the skin and the whites of the eyes look yellow.

A hepatitis C infection can cause damage to your liver (cirrhosis). If you develop cirrhosis, you may have:

  • Redness on the palms of your hands caused by expanded small blood vessels.
  • Clusters of blood vessels just below the skin that look like tiny red spiders and usually appear on your chest, shoulders, and face.
  • Swelling of your belly, legs, and feet.
  • Shrinking of the muscles.
  • Bleeding from enlarged veins in your digestive tract, which is called variceal bleeding.
  • Damage to your brain and nervous system, which is called encephalopathy. This damage can cause symptoms such as confusion and memory and concentration problems.

Many other health problems are linked with long-term cirrhosis. For more information, see the topic Cirrhosis. There also are many other conditions with similar symptoms, such as other liver infections and liver damage caused by drinking too much alcohol.

Contagious and incubation periods

The incubation period-the time it takes for symptoms to appear after the hepatitis C virus has entered your body-is from 2 weeks to 6 months. But not all people have symptoms when they are first infected.

You can spread the virus to someone else at any time after you are infected, even if you don't have symptoms.

What Happens

There are two phases of hepatitis C. The first form is called acute hepatitis C. It means that you recently became infected with the virus. The second form is called chronic hepatitis C. It means that you have had an infection for more than 6 months.

Acute phase

Right after you are infected with hepatitis C, you enter the acute stage. Some people fight off the virus and never have any liver problems. But up to 85% of people who are infected will go on to have chronic hepatitis C.footnote 3

Most people have no symptoms right after they have been infected with hepatitis C. Your symptoms may be blamed on the flu. Since any symptoms are likely to go away in a few weeks, you may not know you have hepatitis C for a long time.

If you have an obvious symptom of hepatitis C, such as jaundice, or if you know you have been exposed to the blood of someone who has hepatitis C, you should be tested for hepatitis C virus infection.

Chronic phase

Long-term hepatitis C often causes tiny scars in your liver. If you have a lot of these scars, it becomes hard for your liver to work well. About 25% of people who develop chronic hepatitis C eventually have more serious liver problems such as cirrhosis or liver cancer, usually over a period of 20 or more years.footnote 4

Certain things may help predict your risk for severe liver damage, such as how much alcohol you drink and the age when you were infected.

If the infection becomes so severe that your liver can no longer function (end-stage liver failure), having a liver transplant may be the only way to extend your life.

What Increases Your Risk

Certain things may increase your risk of becoming infected with the hepatitis C virus. Just because you are at risk for getting hepatitis C does not mean that you have the virus.

Many people do not know how they became infected with hepatitis C.

Needle use or accidental stick

You can get hepatitis C from:

  • Sharing needles and other equipment (such as cotton, spoons, and water) used to inject drugs.
  • Having your ears or another body part pierced, getting a tattoo, or having acupuncture with needles that have not been sterilized properly. The risk of getting hepatitis C in these ways is very low.
  • Working in a health care environment where you are exposed to fresh blood or where you may be pricked with a used needle. Following standard precautions for health care workers makes this risk very low.

Other possible risks

Sometimes people get hepatitis C from:

  • Having had a blood transfusion or organ transplant before 1992. Since 1992, all donated blood and organs are screened for hepatitis C.
  • Having been exposed to unsafe practices for giving shots, such as reusing needles. This occurs in some developing countries.
  • Needing to have your blood filtered by a machine (hemodialysis) because your kidneys cannot filter your blood.
  • Being born to a mother who has hepatitis C. The risk of passing the virus to a child is greater if the mother is also infected with HIV.

People born from 1945 to 1965 are 5 times more likely to be infected with hepatitis C than people born in other years.footnote 5

The risk of getting hepatitis C through sexual contact is very small.footnote 2 The risk is higher if you have many sex partners.

When To Call a Doctor

Call 911 or other emergency services immediately if you have hepatitis C and you:

  • Feel extremely confused or are having hallucinations.
  • Are bleeding from the rectum or are vomiting blood.

Call your doctor if:

  • You think you may have been infected with hepatitis C.
  • You have risk factors for hepatitis C, such as IV drug use.
  • You have symptoms of hepatitis C (fatigue, sore muscles, loss of appetite, nausea, dark urine or yellow-gray stools, fever, or jaundice) and you think you may have been exposed to hepatitis C.
  • A home test for hepatitis C virus shows that you have hepatitis C. More testing is needed to find out if you have an active infection.

Who to see

The following health professionals can diagnose hepatitis C:

The following specialists also can diagnose the disease and provide further care:

Exams and Tests

Because many people don't have symptoms, it's common for people to have hepatitis C for 15 years or longer before it is diagnosed. Many people don't find out that they have the virus until they are tested for some other reason, such as when donating blood. Experts recommend that all adults born from 1945 to 1965 should be tested for hepatitis C.footnote 5, footnote 6 People in this age group are more likely to have hepatitis C and not know it.

It is important to be tested for hepatitis C if you:

  • Have signs or symptoms of liver disease, such as abnormal liver tests.
  • Received blood from a donor who was found to have hepatitis C.
  • Have ever shared needles while using drugs, even if you only experimented many years ago.
  • Are a health care worker who may have been exposed to hepatitis C through a needle stick or other contact with blood or body fluids.
  • Have had your blood filtered by a machine (hemodialysis) because your kidneys cannot filter your blood.
  • Received blood, blood products, or a solid organ from a donor before 1992. Since 1992, all donated blood and organs are screened for hepatitis C. So it is now rare to get the virus this way.
  • Received blood-clotting factor concentrates (used to treat blood disorders such as hemophilia) before 1987. In 1987, screening of clotting factor concentrates for hepatitis C became a requirement.
  • Have HIV infection.

Before you have tests, your doctor will probably talk to you about the pros and cons of testing for hepatitis C so that you understand what having the virus means.

First exam at the doctor's office

Your doctor will:

Tests for the hepatitis C virus

If your doctor thinks that you may have hepatitis C, he or she may order:

  • A hepatitis C virus test. This is a blood test that looks for antibodies against the hepatitis C virus. It shows whether you have been exposed to the virus. A rapid test is available that gives results in 20 minutes.
  • A blood test that looks for the genetic material (RNA) of the hepatitis C virus. This test shows whether you are infected with the virus now.
  • A blood test to find out the kind of hepatitis C virus (genotype) you have. Knowing your genotype will help you and your doctor decide if and how you should be treated.

Home testing for hepatitis C

Some people prefer to find out on their own whether they have been exposed to hepatitis C. In most drugstores you can buy a home test called the Home Access Hepatitis C Check kit. If test results show that you have been exposed to the virus, it is important to discuss these results with your doctor and to find out if you are infected with the virus now.

Tests for liver problems

To check how well your liver is working, you may have:

Other tests

If you have a hepatitis C virus test, you may also get tested for HIV.

Treatment Overview

Experts recommend that nearly everyone who has hepatitis C receive treatment. Talk with your doctor about whether you should get treatment.

Newer medicines almost always work to treat hepatitis C. But they have side effects, and they cost a lot.

Being diagnosed with hepatitis C can change your life. You may need help and support to cope with the illness. For more information, see Home Treatment.

Treatment of short-term (acute) hepatitis C

Most people who have acute hepatitis C don't get treated, because they don't know that they have the virus.

If a person knows that he or she may have been exposed to the virus-such as a health care worker who is stuck by a needle-acute hepatitis C can be found early. Most people who are known to have an acute hepatitis C infection get treated with medicine. In these cases, treatment may help prevent long-term (chronic) infection, although there is still some debate over when to begin treatment and how long to treat acute hepatitis C.footnote 7

Treatment of long-term (chronic) hepatitis C

It is common for people to live with hepatitis C for years without knowing they have it, because they do not have symptoms. So most people diagnosed with hepatitis C find out that they already have long-term, chronic infection.

Treatment with antiviral medicines can fight the viral infection and prevent serious liver problems like cirrhosis or liver cancer.

You will need to have routine blood tests to help your doctor know how well your liver is working.

Palliative care

Palliative care is a kind of care for people who have a serious illness. It's different from care to cure your illness. Its goal is to improve your quality of life-not just in your body but also in your mind and spirit.

You can have this care along with treatment to cure your illness. You can also have it if treatment to cure your illness no longer seems like a good choice.

Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.

If you're interested in palliative care, talk to your doctor.

For more information, see the topic Palliative Care.

Treatment of relapse or nonresponse

Sometimes you may need to take a different combination of medicines if your first round of treatment didn't work very well. If it was not done before, your doctor may do a test to find out which genotype caused the infection. This may help the doctor choose a medicine that is more likely to cure the infection.

Treatment if the condition gets worse

Severe liver damage caused by chronic hepatitis C usually takes 20 or more years to develop.

If your hepatitis C continues to get worse, it can cause your liver to stop working, a condition called end-stage liver failure. In this case, a liver transplant may be the only way to extend your life. But if you are drinking alcohol, are sharing needles to inject drugs, or have severe depression or certain other mental illnesses, liver transplant may not be an option.

End-of-life issues

Most people with chronic hepatitis C will not die from the disease. But 1 to 5 out of 100 people with severe liver damage from chronic hepatitis C will die because of the virus.footnote 8 Even if a liver transplant is done as a last possible treatment, there can be complications that lead to death. For more information about decisions to help prepare for death and dying, see the topic Care at the End of Life.

What to think about

There is no vaccine for hepatitis C, but there are vaccines for hepatitis A and hepatitis B. Your doctor may recommend that you have these vaccines to help protect you from more liver problems.

Researchers are working to develop other treatments, including gene therapy and medicines that help control the immune system.

Prevention

There is no vaccine to prevent hepatitis C. But you can reduce your risk of becoming infected:

  • Don't share needles or other equipment (such as cotton, spoons, and water) if you inject drugs. Many cities have needle exchange programs that provide free, sterile needles so that you don't have to share needles. If you want to stop using drugs, ask your doctor or someone you trust to help you find out about drug treatment programs.
  • Follow safety guidelines if you work in health care. Wear protective gloves and clothing, and dispose of needles and other contaminated sharp objects properly.
  • Make sure the practitioner sterilizes the instruments and supplies if you get a tattoo, have your body pierced, or have acupuncture.

If you have hepatitis C, you can help prevent spreading it to others:

  • Don't share needles or other equipment such as cotton, spoons, and water if you continue to use needles to inject drugs.
  • Keep cuts, scrapes, and blisters covered to prevent others from coming in contact with your blood and other body fluids. Throw out any blood-soaked items such as used Band-Aids.
  • Don't donate blood, sperm, or eggs.
  • Wash your hands-and any object that has come in contact with your blood-thoroughly with water and soap.
  • Don't share your toothbrush, razor, nail clippers, diabetes supplies, or anything else that might have your blood on it.

Breastfeeding mothers who have hepatitis C can continue to breastfeed their babies, because hepatitis C cannot be spread through breast milk. If you are breastfeeding, try to avoid having cracked nipples, which might pose a risk of spreading the virus to your baby.

Home Treatment

Some people who have hepatitis C don't notice a big difference in the way they feel. Others feel tired, sick, or depressed. The following are steps you can take at home that may help you feel better both physically and emotionally.

Slow down

It is very common to feel tired if you have hepatitis C. If you feel tired, give yourself permission to do less and rest more. If possible, ask others to help out around your home or ask your employer for a shorter or more flexible work schedule.

Exercise

Exercise if you feel up to it. Aerobic exercise can help you have more energy and may also improve depression. It is best to avoid any strenuous activities on the day after you receive peginterferon.footnote 9

Eat regular, nutritious meals

Sometimes people with hepatitis C have a hard time eating. You may have no appetite, feel nauseated, or have different tastes than you are used to. Even if you don't feel like eating, it's very important to eat small meals throughout the day. Some people have nausea in the afternoon. If this happens to you, try to eat a big, nutritious meal in the morning.

If you have cirrhosis, it may not be a good idea to eat salty foods or foods that are high in protein. If you want to know more about which foods to avoid and which foods are good to eat, ask your doctor about meeting with a registered dietitian to discuss a healthy eating plan.

Avoid alcohol and drugs

One of the most important jobs of your liver is to break down drugs and alcohol. If you have hepatitis C, one of the best things you can do is to avoid substances that may harm your liver, such as alcohol and illegal drugs. If you have cirrhosis, you also may need to avoid certain medicines.

If you use illegal drugs or drink alcohol, it is important to stop. Being honest with your doctor about your drug and alcohol use will help you deal with any substance abuse problems. If you don't feel that you can talk openly with your doctor, you may want to find a doctor you feel more comfortable with. If you want to stop using drugs or alcohol and need help to do so, ask your doctor or someone else you trust about drug and alcohol treatment options.

Because many medicines can stress your liver, talk to your doctor before you take any prescription or over-the-counter medicines. This includes herbal remedies as well.

Control itching

If you have itchy skin, ask your doctor about taking nonprescription medicines, such as diphenhydramine (for example, Benadryl) or chlorpheniramine (for example, Chlor-Trimeton), to relieve itching. If you do take these medicines, be sure to follow the instructions and to stop using the medicine if you have any side effects.

Seek help for depression

You may feel angry or depressed about having to live with a long-term, serious disease. You may have a hard time knowing how to tell other people that you have the virus. It can be helpful to talk with a social worker or counselor about what having the disease means to you. You also may want to find a support group for people with hepatitis C. If you don't have a support group in your area, there are several on the Internet.

Depression may develop in anyone who has a long-term illness. It also can be a side effect of antiviral medicines for hepatitis C. If you are feeling depressed, talk to your doctor about antidepressant medicines and/or counseling. For more information, see the topic Depression.

Learn about the disease

Learning about hepatitis C may help you feel more in control of the disease. The more you understand, the better you can make decisions about treatment and lifestyle changes that may help you feel better, both physically and emotionally.

Medications

Most people who are known to have an acute hepatitis C infection get treated with antiviral medicine if the infection does not clear up on its own. Treatment for acute hepatitis C may help prevent long-term (chronic) infection.

Antiviral medicines also are used to treat long-term (chronic) hepatitis C. These medicines can help prevent the hepatitis C virus from damaging your liver.

Newer medicines for treating hepatitis C are much better than the old medicines were at permanently lowering the amount of virus in your blood. With the new medicines, most people can be cured, but there are side effects and the treatment is costly.

What to think about

If you have tried interferon in the past and didn't get good results, talk to a doctor who is a liver specialist (hepatologist). He or she will be able to tell you about newer medicines that are producing good results and about experimental medicines that are being developed.

Surgery

If chronic hepatitis C damages your liver so severely that it no longer works well (end-stage liver failure), you may need a liver transplant to extend your life. Liver transplants aren't common.

Surgery choices

A liver transplant is the only surgical treatment that can help people with end-stage liver failure.

What to think about

Liver transplantation is a risky, expensive procedure. And donor organs are hard to get. Most of the time, only people who are in good health (other than having liver disease) are considered for a transplant. You will not be considered if you are drinking alcohol, using illegal drugs, or have certain mental health problems.

After a liver transplant, you will need lifelong follow-up care by a specialist. You also will need to take immunosuppressant medicine to keep your body from rejecting the new liver. This medicine may cause other problems.

Other Treatment

Some people seek out complementary medicines or alternative ways to treat their hepatitis C. At this time, no complementary or alternative medicines have been proved to reduce symptoms or cure hepatitis C. In fact, some herbal therapies (such as kava) may actually damage the liver.footnote 10

Rigorous studies of the herb milk thistle show that it does not protect the liver from damage.footnote 11, footnote 12 Talk to your doctor if you are thinking about trying milk thistle or any other complementary therapy to treat hepatitis C.

References

Citations

  1. Terrault NA, et al. (2013). Sexual transmission of hepatitis C virus among monogamous heterosexual couples: The HCV Partners Study. Hepatology, 57(3): 881-889.
  2. Terrault NA, et al. (2013). Sexual transmission of hepatitis C virus among monogamous heterosexual couples: The HCV Partners Study. Hepatology, 57(3): 881-889.
  3. Dienstag JL, Delemos AS (2015). Viral hepatitis. In JE Bennett et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 8th ed., vol. 1, pp. 1438-1468. Philadelphia: Saunders.
  4. Flamm SL (2003). Chronic hepatitis C virus infection. JAMA, 289(18): 2413-2417.
  5. Smith BD, et al. (2012). Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965. MMWR, 61(RR-4): 1-32. Available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6104a1.htm.
  6. U.S. Preventive Services Task Force (2013). Screening for Hepatitis C Virus Infection in Adults: Recommendation Statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspshepc.htm.
  7. Wiegand J, et al. (2006). Early monotherapy with pegylated interferon alfa-2b for acute hepatitis C infection: The HEP-NET Acute HCV-II Study. Hepatology, 43(2): 250-256.
  8. Centers for Disease Control and Prevention (2012). Hepatitis C FAQs for health professionals. Available online: http://www.cdc.gov/hepatitis/HCV/HCVfaq.htm.
  9. Ward RP, et al. (2004). Management of hepatitis C: Evaluating suitability for drug therapy. American Family Physician, 69(6): 1429-1438.
  10. U.S. Food and Drug Administration (2009). Consumer advisory: Kava-containing dietary supplements may be associated with severe liver injury. Available online: http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm085482.htm.
  11. National Center for Complementary and Alternative Medicine (2012). Get the Facts: Hepatitis C: A Focus on Herbal Supplements (NCCAM Publication No. D422). Washington, DC: U.S. National Institutes of Health. Available online: http://nccam.nih.gov/health/hepatitisc/hepatitiscfacts.htm.
  12. Fried MW, et al. (2012). Effect of silymarin (milk thistle) on liver disease in patients with chronic hepatitis C unsuccessfully treated with interferon therapy: A randomized controlled trial. JAMA, 308(3): 274-282.

Credits

ByHealthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Martin J. Gabica, MD - Family Medicine
Adam Husney, MD - Family Medicine
W. Thomas London, MD - Internal Medicine, Hepatology

Current as ofNovember 18, 2017

Current as of: November 18, 2017

Author: Healthwise Staff

Medical Review: E. Gregory Thompson, MD - Internal Medicine & Martin J. Gabica, MD - Family Medicine & Adam Husney, MD - Family Medicine & W. Thomas London, MD - Internal Medicine, Hepatology