Hepatitis C (HCV) Overview

Hepatitis C is a disease of the liver caused by infection from the hepatitis C virus (HCV). The virus is primarily transmitted through exposure to infectious blood or body fluids that contain blood. HCV infection can lead to both acute and chronic liver disease. Curative treatments are available, so early diagnosis and treatment are crucial to prevent severe liver damage and prevent ongoing transmission.

If the inflammation is not reversed, it becomes chronic (ongoing, long-term) and can cause chronic liver disease, which can be serious or even fatal. At least 75 percent of people infected with hepatitis C develop chronic hepatitis C. If the disease progresses to the point at which the liver begins to fail (end-stage liver disease), the only treatment is liver transplantation.

Hepatitis C is an increasing public health concern in the United States and throughout the world. HCV is one of the most common causes of chronic liver disease in the United States and the most common cause of chronic viral hepatitis. HCV is not related to the other viruses that cause hepatitis. Like the other hepatitis viruses, however, it is contagious. 

Hepatitis C Types

  • Acute hepatitis C — occurs within first 6 months of exposure to HCV; can be short-term illness, but for most people, acute infection leads to chronic infection.
  • Chronic hepatitis C — can be lifelong infection if left untreated; developed by over 50% of people infected with HCV; can lead to liver damage, cirrhosis (scarring of the liver), liver cancer, and even death. 

Hepatitis C Signs and Symptoms

People with chronic hepatitis C are usually asymptomatic, meaning they do not have symptoms, or have general symptoms like chronic tiredness or depression. Yet even people without symptoms can spread the virus to others. If you do develop symptoms, you will notice them 2 1/2 weeks after infection with the virus. Signs can include:

  • Dark urine or clay-colored stools
  • Feeling tired
  • Fever
  • Joint pain
  • Loss of appetite
  • Nausea, stomach pain, throwing up
  • Yellow skin or eyes (jaundice)

Hepatitis C Risk Factors

The hepatitis C virus is transmitted mainly by contact with blood or blood products; mucous membrane exposures to blood can also result in transmission.

Most common mode of transmission:

  • Sharing of contaminated needles among IV drug users

Once a common, now rare:

  • Transfusion with infected blood or blood products, hemodialysis, or transplantation of organs from infected donors

Other less common modes of transmission include:

  • Childbirth
  • Sexual contact
  • Tattooing in unregulated facilities
  • Needles or other sharp instruments
  • Sharing personal items contaminated with infectious blood, such as razors or toothbrushes
  • Donated blood, blood products, and organs (rare in the US since blood screening became available in 1992)

Hepatitis C At-Risk Populations

  • People who inject drugs or did so in the past.
  • People with human immunodeficiency virus (HIV) infection.
  • People with certain medical conditions, including those who have ever received maintenance hemodialysis and those with persistently abnormal alanine aminotransferase (ALT) (a liver enzyme) levels.
  • Health care and public safety personnel who have been exposed to the blood of someone who has hepatitis C (through needle sticks, sharps, or mucosal exposures).
  • Infants born to people with known hepatitis C.
  • Organ transplant and transfusion recipients.
  • People who received clotting factor concentrates produced before 1987.
  • People who received a transfusion of blood or blood components before July 1992.
  • People who received an organ transplant before July 1992.
  • People who were notified that they received blood from a donor who later tested positive for HCV infection.

Hepatitis C Long-Term Risks

HCV is believed to be the cause of about 15-20 percent of all cases of acute (new, short-term) viral hepatitis and half of all cases of cirrhosis, end-stage liver disease, and liver cancer (hepatocellular carcinoma). Some people with chronic HCV infection develop chronic medical conditions unrelated to the liver, including:

  • Diabetes mellitus
  • Glomerulonephritis
  • Essential mixed cryoglobulinemia
  • Porphyria cutanea tarda
  • Non-Hodgkin’s lymphoma

Hepatitis C Treatment

Current drug treatments for chronic HCV infection:

The standard of care for hepatitis C treatment is weekly injections of a drug called pegylated interferon alfa combined with twice-daily oral doses of ribavirin (Rebetol), a broad-spectrum antiviral agent. Two pegylated interferon medications are available, peginterferon alfa-2b (Peg-Intron) and peginterferon alfa-2a (Pegasys). The goal of HCV treatment is to clear the virus from your bloodstream. Combined pegylated interferon and ribavirin clear HCV infection in 40 percent to 80 percent of those treated.

Interferon side effects include severe flu-like symptoms, irritability, depression, concentration and memory problems, skin irritation, fatigue, and insomnia. Ribavirin can cause a low red blood cell count (anemia), itchiness, nasal congestion, skin irritation, fatigue, and birth defects.

Combination therapy including pegylated interferon and ribavirin may cause psychosis or suicidal behavior in a small number of people.

Other Resources and Support

https://www.cdc.gov/hepatitis-c/hcp/clinical-overview/

https://www.cdc.gov/hepatitis-c/about/index.html

https://www.cdc.gov/hepatitis-c/signs-symptoms/index.html

https://www.cdc.gov/hepatitis-c/public-resources/index.html

https://www.mayoclinic.org/diseases-conditions/hepatitis-c/symptoms-causes/syc-20354278

https://www.hepatitis.va.gov/hcv/index.asp

https://www.hepatitis.va.gov/pdf/Hepatitis-C-Factsheet-Veterans.pdf