Hepatitis C

Overview

Hepatitis C is an infection of the liver caused by the hepatitis C virus (HCV). It spreads mainly through blood-to-blood contact. Unlike hepatitis B, there is no vaccine for hepatitis C, but unlike in the past, the infection can now be cured in most people with a short course of modern antiviral medicines.

Many people who become infected develop chronic hepatitis C, meaning the virus stays in the body long term. The infection often causes no symptoms for years or even decades, even while it slowly damages the liver. Over time, untreated chronic hepatitis C can lead to cirrhosis (severe liver scarring), liver failure, and liver cancer. Because the infection is so often silent, testing is essential for finding and curing it before serious liver damage develops. Treatment advances have made hepatitis C one of the most treatable chronic viral infections.

Symptoms

Most people with new hepatitis C have no symptoms, and chronic infection is frequently silent for many years. When symptoms appear, they may include:

• Fatigue and a general feeling of being unwell
• Yellowing of the skin and eyes (jaundice)
• Dark urine and pale stools
• Nausea and loss of appetite
• Abdominal pain or discomfort
• Joint and muscle aches

Because symptoms are often absent until the liver is significantly affected, signs of advanced liver disease, such as fluid buildup in the abdomen, easy bruising, or confusion, may be the first noticeable problems. Testing at-risk people is the only reliable way to detect the infection early.

Causes

Hepatitis C is caused by the hepatitis C virus entering the bloodstream, almost always through contact with infected blood.

• Sharing needles or drug equipment: the most common route in many countries today.
• Unsafe medical or injection practices: contaminated equipment or, in the past, unscreened blood transfusions.
• Mother to baby: can occur during childbirth, though less commonly than with hepatitis B.
• Less common routes: unsterile tattooing or piercing, sharing razors, and rarely sexual contact.

Hepatitis C is not spread by casual contact such as hugging, sharing food or utensils, coughing, or sneezing.

Risk Factors

Risk relates mainly to potential exposure to infected blood.

• Past or present injection drug use, even once long ago
• Receiving a blood transfusion or organ transplant before widespread screening
• Long-term hemodialysis
• Being born to a mother with hepatitis C
• Unsterile tattooing or piercing
• Healthcare work with needlestick exposure

Diagnosis

Hepatitis C is diagnosed with blood tests, often starting with a screening test followed by confirmation.

• Antibody test: screens for exposure to the virus; a positive result means the person has been infected at some point.
• HCV RNA test: confirms current, active infection by detecting the virus itself.
• Genotype testing: identifies the strain of the virus, which can guide treatment.
• Liver function tests and imaging: assess liver inflammation and the degree of scarring.
• Elastography: a noninvasive scan that estimates liver stiffness and fibrosis.

Many guidelines now recommend at least one hepatitis C test for all adults, since the infection is so often silent.

Treatment

Treatment for hepatitis C has been transformed by direct-acting antiviral medicines, which cure most people with a relatively short, well-tolerated course of pills.

• Direct-acting antivirals (DAAs): oral medicines, usually taken for about 8 to 12 weeks, that clear the virus in the great majority of people.
• Cure confirmation: a blood test some weeks after finishing treatment confirms the virus is gone (a sustained virologic response).
• Managing liver damage: people who already have significant scarring need ongoing monitoring even after the virus is cured.
• Avoiding further harm: stopping alcohol and treating other liver conditions support recovery.

Curing the infection greatly reduces the risk of cirrhosis, liver failure, and liver cancer, especially when treatment begins before severe damage has occurred.

Prevention

• Never share needles, syringes, or other drug-injection equipment
• Ensure tattoo and piercing equipment is sterile and single-use
• Do not share razors, toothbrushes, or other items that may carry blood
• Follow safe practices in healthcare to avoid needlestick injuries
• Get tested if you have any risk factors, since early treatment prevents complications
• Use condoms, especially in higher-risk situations

When to See a Doctor

See a clinician to get tested if you have any risk factors for hepatitis C, even if you feel completely well, since the infection is usually silent and is now curable. Also seek care if you develop jaundice, dark urine, persistent fatigue, or abdominal discomfort. Seek urgent medical attention for signs of advanced liver disease, such as:

• Vomiting blood or black, tarry stools
• Significant abdominal swelling
• Marked jaundice with confusion or extreme drowsiness

These can indicate serious liver complications that require immediate care.

Related Topics

Frequently Asked Questions

References

1. Centers for Disease Control and Prevention (CDC). Hepatitis C.
2. World Health Organization (WHO). Hepatitis C.
3. Mayo Clinic. Hepatitis C — Symptoms and causes.
4. MedlinePlus, U.S. National Library of Medicine. Hepatitis C.