Hepatitis C

What hepatitis C is

Hepatitis means inflammation of the liver. The hepatitis C virus is one of several viruses that cause it. Our pages on hepatitis and viral hepatitis compare the types. Hepatitis C is distinct because it rarely causes illness at first, often becomes chronic, has no vaccine, and is curable with tablets.

After infection, about 25 to 30% of people clear the virus on their own within six months. The rest develop chronic hepatitis C. Over 20 to 30 years, ongoing inflammation lays down scar tissue (fibrosis). Roughly 15 to 30% of people with chronic infection develop cirrhosis over that time, and people with cirrhosis have a yearly risk of liver cancer of a few percent. Alcohol, obesity, fatty liver, HIV and hepatitis B speed the damage up.

How do you get hepatitis C?

Hepatitis C spreads when blood from an infected person enters someone else's bloodstream.

Main routes

• Sharing needles, syringes or other drug equipment (spoons, filters, water, straws for snorting). This is the leading cause in the US.
• Unsterile tattooing or piercing.
• Blood transfusions or organ transplants before 1992, before screening began.
• Mother to baby during birth, in about 5 to 6% of infected pregnancies.
• Needlestick injuries in health care.
• Sex: uncommon between long-term monogamous partners, but higher with anal sex, multiple partners, HIV or other STIs.
• Shared razors or toothbrushes: possible, low risk.

How it does not spread

Hugging, kissing, sharing food or drinks, coughing, sneezing, breastfeeding (unless nipples are cracked and bleeding), or casual contact.

Hepatitis C symptoms

Acute (new) infection

Most people have no symptoms. About 20 to 30% develop symptoms 2 to 12 weeks after exposure:

• Tiredness, low appetite and nausea
• Pain in the upper right belly
• Dark urine, pale stools and jaundice
• Fever and joint pain

Chronic infection

Usually silent for years, or causing vague tiredness, brain fog and aches. Once cirrhosis develops, signs of liver damage appear:

• Easy bruising and bleeding
• Swollen belly (ascites) and swollen legs
• Itchy skin
• Spider-like blood vessels on the chest
• Confusion from toxins the liver cannot clear (hepatic encephalopathy)
• Vomiting blood from swollen veins in the esophagus

Hepatitis C also affects other organs: it can cause cryoglobulinemia (inflamed blood vessels with rash and joint pain), kidney disease, a blistering skin condition (porphyria cutanea tarda), and higher rates of type 2 diabetes and some lymphomas.

Who should get tested

The CDC recommends:

• All adults 18 and older at least once.
• Every pregnant person, in each pregnancy.
• Regular testing for people with ongoing risk, such as current injection drug use.
• Anyone with abnormal liver tests, past injection drug use, HIV, dialysis, a needlestick exposure, or a mother with hepatitis C.

Hepatitis C test

1. HCV antibody test: shows whether you have ever been infected. It stays positive for life, even after cure.
2. HCV RNA (viral load) test: if antibodies are positive, this confirms whether the virus is active now. Many labs do it automatically on the same sample.
3. Before treatment: liver blood tests, a check for hepatitis B and HIV, and an assessment of scarring with a FibroScan (elastography) or a blood score such as FIB-4. A liver biopsy is rarely needed.

Testing too soon after a recent exposure can miss it. Antibodies take 8 to 11 weeks to appear, but the RNA test can be positive within 1 to 2 weeks.

Hepatitis C treatment and cure

Direct-acting antivirals (DAAs) transformed hepatitis C treatment. They target proteins the virus needs to copy itself.

• Common regimens: sofosbuvir-velpatasvir for 12 weeks, or glecaprevir-pibrentasvir for 8 weeks. Both work against all genotypes.
• Side effects: usually mild, such as headache or tiredness.
• Cure: defined as no detectable virus 12 weeks after finishing (sustained virologic response, SVR). This is achieved in over 95% of people.
• Who can be treated: almost everyone with chronic infection, including people who currently use drugs, people with cirrhosis and many with kidney disease. Many primary care doctors now prescribe treatment.
• Cautions: tell your doctor about all medicines and supplements, especially acid reducers, amiodarone, seizure medicines and St John's wort. Hepatitis B can flare during treatment in people who also carry it, so they are monitored.

Cure stops liver damage from getting worse, and fibrosis often improves. People who already have cirrhosis still need liver cancer screening with an ultrasound every 6 months after cure.

Living with hepatitis C

• Avoid alcohol, which speeds liver scarring.
• Get vaccinated against hepatitis A and hepatitis B.
• Check with a doctor before taking herbal supplements. Acetaminophen (paracetamol) at the label dose is usually fine, but ask about limits if you have cirrhosis.
• Do not share razors, toothbrushes, nail clippers or any drug equipment.
• Cover cuts and clean blood spills with bleach.

Preventing hepatitis C and reinfection

There is no vaccine, and being cured does not protect you. Use new, sterile needles and equipment every time (syringe service programs and pharmacies can help), choose licensed tattoo and piercing studios, use condoms with new or multiple partners, and follow standard precautions at work.

Frequently asked questions

How do you get hepatitis C?

Through blood-to-blood contact. The most common route today is sharing needles or other drug equipment. Other routes include unsterile tattoos, blood transfusions before 1992, birth to an infected mother, needlestick injuries and, less often, sex. It is not spread by kissing, hugging or sharing food.

Is hepatitis C curable?

Yes. Direct-acting antiviral tablets taken for 8 to 12 weeks cure more than 95% of people, with few side effects. Cure is confirmed by a blood test 12 weeks after treatment ends. You can be reinfected later, so ongoing prevention matters.

What are the first symptoms of hepatitis C?

Most people have no early symptoms. When they occur, 2 to 12 weeks after infection, they include tiredness, nausea, poor appetite, pain under the right ribs, dark urine and yellow eyes. Because symptoms are uncommon, a blood test is the only reliable way to know.

How long can you have hepatitis C without knowing?

Often decades. Chronic hepatitis C commonly causes no clear symptoms for 20 to 30 years while liver scarring builds. Many people are diagnosed only when cirrhosis or liver cancer appears, which is why one-time testing of all adults is recommended.

Can hepatitis C be spread through sex?

It can, but the risk is low for monogamous heterosexual couples. Risk is higher with multiple partners, anal sex, sex involving blood, and in people with HIV or other STIs. Condoms reduce the risk. Sharing razors or toothbrushes also carries some risk.

Does a positive hepatitis C antibody test mean I have it?

Not necessarily. Antibodies show past or present infection and remain positive after spontaneous clearance or cure. An HCV RNA test is needed to show whether the virus is currently active. Only a positive RNA test means you need treatment.