Originally published by Harvard Health.

What Is It?

Hepatitis C is a viral infection. It can inflame and damage the liver.

Hepatitis C is usually transmitted through contact with infected blood. It can be spread through:

• Shared needles during intravenous drug use
• Shared devices used to snort cocaine
• Unprotected sexual intercourse (this is uncommon)
• Accidental stick with a contaminated needle
• Blood transfusions (rare because of improved screening techniques since 1992)
• Renal dialysis
• Childbirth, from mother to child during delivery
• Contaminated tattoo or body piercing equipment

The hepatitis C virus can cause short-term (acute) or long-term (chronic) hepatitis C. Most people with acute hepatitis C eventually develop chronic hepatitis C.

Most people with hepatitis C don’t know that they are infected. That’s because hepatitis C usually does not cause symptoms.

After having this silent infection for 20 to 30 years, about one-third of people develop cirrhosis. Cirrhosis is a serious liver disease that can lead to death. A smaller group of people with chronic hepatitis C develop liver cancer.

The United States Preventive Services Task Force and Centers for Disease Control and Prevention recommend screening for hepatitis C virus (HCV) infection in people at higher than average risk. Also there is a high prevalence of infection in adults born between 1945 and 1965. If you were born during that time, you should get a one-time simple blood test to make sure you are not infected.

Symptoms

Many people with hepatitis C do not have any symptoms.

Some people develop symptoms that last for up to 3 months. These symptoms include:

• A general sick feeling
• A yellowish discoloration of the skin
• Weakness
• Poor appetite
• Fatigue
• Nausea
• Abdominal pain

Some people with acute hepatitis C completely eliminate the virus from their bodies. They don’t suffer any long-term consequences.

But the majority of people with acute hepatitis C remain infected. They develop chronic hepatitis C.

Only some people with long-term hepatitis C develop symptoms. These symptoms include:

• Weight loss
• Poor appetite
• Fatigue
• Aching joints

Most people with chronic hepatitis C do not have any symptoms for 20 to 30 years. All the while, however, the virus slowly damages their livers. Unless they are tested for hepatitis C, many of these people do not know that they are infected. That is, until they develop the symptoms of advanced liver disease.

Diagnosis

To make a diagnosis, your doctor will ask about symptoms of hepatitis C or advanced liver disease.

He or she will ask about your exposure to risk factors for hepatitis C. These include:

• A history of intravenous drug use
• A history of nasal cocaine use
• Blood transfusions, especially before 1992
• Multiple sexual partners
• Previous or current work in the health care field.
• History of hemodialysis

Your doctor will examine you. He or she will look for evidence of liver disease, such as:

• Enlarged liver or spleen
• Swollen abdomen
• Ankle swelling
• Muscle wasting

Hepatitis C infection is confirmed by certain tests. One test looks for hepatitis C virus in your blood. Another test detects infection-fighting proteins (antibodies). Antibodies to hepatitis C indicate that you have been exposed to the virus.

If you have hepatitis C, blood tests can determine the subtype of virus. Different subtypes respond differently to treatment.

You may need a liver biopsy. In a biopsy, a small piece of liver tissue is removed and examined in a laboratory. The biopsy helps predict whether you will develop complications from liver disease.

Expected Duration

Most people with hepatitis C have the infection for life. Some eventually develop cirrhosis or other forms of severe liver disease.

Prevention

There is no vaccine to protect against hepatitis C. The only way to prevent this disease is to avoid the risk factors.

The most effective ways to prevent hepatitis C:

• Don’t inject illegal drugs.
• Don’t snort cocaine.
• Make sure body piercing or tattooing is done using clean equipment.
• If you are a health care worker, follow standard infection control precautions.
• Avoid unprotected sexual intercourse unless you are in a long-term relationship with one person.

It is rare for someone in a monogamous, long-term relationship with an infected partner to become infected. Discuss your need for precautions with your doctor.

Drinking alcohol makes hepatitis C worse. If you have hepatitis C, significantly limit or avoid alcohol.

Treatment

Not everyone infected with hepatitis C needs treatment. Discuss the potential benefits and side effects of treatment with your doctor.

Treatment often includes a medication called alpha interferon. Alpha interferon is a man-made form of a substance produced by the immune system. It is given in combination with ribavirin (Virazole), an antiviral drug. The effectiveness varies with the subtype of the virus.

In the United States, the most common subtype is genotype 1. About 50% of people with this variant of hepatitis C respond to the combination of interferon and ribavirin.

Some people are unable to tolerate the side effects of this treatment. Alpha interferon is not recommended for people who have a history of:

• Depression
• Autoimmune diseases
• Certain blood diseases
• Certain other chronic medical conditions

Ribavirin is tolerated more easily. Its main side effect is anemia.

Four newer antiviral drugs are approved to treat hepatitis C. Three of them are called protease inhibitors. They include boceprevir (Victrelis), telaprevir (Incivek) and simeprevir (Olysio). The fourth is a viral polymerase inhibitor called sofosbuvir (Sovaldi).
These drugs should not be used alone to treat hepatitis C. With addition of one of these drugs to the interferon-ribavirin combination, clearance of the virus can dramatically improve.

When one of these newer drugs is added to the combination of interferon and ribavirin, there is a better chance of a lasting viral response (like a cure). This is known as triple therapy. The percentage of a lasting response is less if chronic hepatitis has advanced to cirrhosis.

Your doctor will recommend hepatitis A and B vaccinations. This will reduce the chance that you will have further liver damage.

When To Call a Professional

Call your doctor if you have symptoms of hepatitis C. Also call if you may have been exposed to the virus.

The Centers for Disease Control and Prevention recommends that anyone born between 1945 and 1965 consider getting a one-time blood test for hepatitis C.

High-risk individuals should be tested for hepatitis C. High-risk individuals include anyone who:

• Received transfusions of blood or blood products before 1992
• Received an organ transplant before 1992
• Has ever injected drugs or snorted cocaine
• Has been on long-term hemodialysis
• Has had multiple sexual partners
• Has a long-term sexual partner with hepatitis C
• Lives in the same household as someone with hepatitis C
• Has evidence of liver disease

Prognosis

Most people infected with hepatitis C virus eventually develop chronic hepatitis C.

Long-term complications often do not develop until after decades of infection. At that time, some people develop cirrhosis. A smaller group of people develop liver cancer.

Anti-viral therapy can decrease the risk of long-term complications in some people.

Additional Info

American Liver Foundation
75 Maiden Lane, Suite 603
New York, NY 10038
Phone: 212-668-1000
Toll-Free: 1-800-465-4837
Fax: 212-483-8179
http://www.liverfoundation.org