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What is Hepatitis C?
Hepatitis C is a viral infection that causes inflammation of the liver and can lead to serious liver damage. The disease is caused by the hepatitis C virus (HCV), which is a bloodborne virus primarily transmitted through direct contact with infected blood.
Unlike hepatitis A and B, there is no vaccine for hepatitis C. However, with recent advances in antiviral medications, hepatitis C is now curable in most cases. If left untreated, hepatitis C can become a chronic infection that may lead to serious health problems including cirrhosis (liver scarring), liver cancer, and liver failure.
If you’re concerned about hepatitis C or other STDs, call (866) 566-8711 to learn about testing options.
How Common is Hepatitis C?
- Approximately 2.4 million people in the United States are living with hepatitis C
- Globally, an estimated 58 million people have chronic hepatitis C infection
- About 50% of people with hepatitis C don’t know they’re infected
- Approximately 44,700 new infections occur in the U.S. each year
- Baby boomers (born 1945-1965) have 5 times the rate of infection compared to other adults
- Hepatitis C causes about 14,000 deaths in the U.S. annually
- Rates of new infections have been increasing since 2010, particularly among young adults
How Hepatitis C Spreads
Hepatitis C is transmitted primarily through direct contact with infected blood. The virus can survive outside the body on surfaces for up to 3 weeks.
Hepatitis C is transmitted through:
- Sharing needles or other equipment to inject drugs
- Needlestick injuries in healthcare settings
- Being born to a mother with hepatitis C (less common)
- Sharing personal items that may have blood on them (razors, toothbrushes)
- Unregulated tattoos or body piercings using unsterile equipment
- Blood transfusions or organ transplants before 1992 (when widespread screening began)
- Sexual contact (uncommon but possible, especially if there are open sores or rough sex that causes bleeding)
- Certain types of sexual activity with multiple partners or that may cause bleeding
Hepatitis C is NOT spread through:
- Casual contact
- Hugging or holding hands
- Sharing food, drinks, or utensils
- Breastfeeding (unless nipples are cracked or bleeding)
- Coughing or sneezing
- Food or water
- Mosquito bites or other insect vectors
Hepatitis C Symptoms
Most people with acute (new) hepatitis C don’t experience symptoms. When symptoms do occur, they typically appear 2-12 weeks after exposure and may include:
Acute Hepatitis C Symptoms
- Fever
- Fatigue
- Loss of appetite
- Nausea and vomiting
- Abdominal pain, especially in the liver area (upper right side)
- Dark urine
- Clay-colored stool
- Joint pain
Chronic Hepatitis C Symptoms
Many people with chronic hepatitis C remain symptom-free until liver damage becomes significant, which may take decades. Symptoms of advanced liver disease may include:
- Persistent fatigue
- Easily bruising or bleeding
- Itchy skin
- Fluid accumulation in the abdomen (ascites)
- Swelling in the legs
- Weight loss
- Spider-like blood vessels on the skin (spider angiomas)
- Confusion, drowsiness, and slurred speech (hepatic encephalopathy)
- Jaundice
Important Facts About Hepatitis C Symptoms
- 70-80% of people with acute hepatitis C have no symptoms
- Symptoms may appear 2-12 weeks after exposure
- Chronic infection develops in 75-85% of those with acute hepatitis C
- Many people with chronic hepatitis C remain asymptomatic for 20-30 years
- Symptoms often don’t appear until liver damage has occurred
- Symptoms may come and go in chronic infection
Acute vs. Chronic Hepatitis C
Hepatitis C infection occurs in two stages: acute and chronic.
Acute Hepatitis C:
- Refers to the first 6 months after infection
- 15-25% of people clear the virus spontaneously without treatment
- Most people have mild or no symptoms
- Diagnosis during this phase is uncommon due to lack of symptoms
- Treatment during acute phase can prevent chronic infection
Chronic Hepatitis C:
- Defined as infection lasting more than 6 months
- Develops in 75-85% of people with acute hepatitis C
- Can persist for decades without symptoms
- Slowly damages the liver over time
- Can lead to cirrhosis in 10-20% of cases within 20-30 years
- Increases risk of liver cancer and liver failure
- Now curable in most cases with antiviral medications
Hepatitis C Genotypes
Hepatitis C virus has several genetic variations or genotypes, which can affect treatment decisions:
- Genotype 1: Most common in the United States (75% of cases) and more difficult to treat with older medications
- Genotype 2: Less common in the U.S. and generally easier to treat
- Genotype 3: Associated with a higher risk of liver steatosis (fatty liver) and faster disease progression
- Genotype 4: More common in Africa and the Middle East
- Genotype 5: Mainly found in South Africa
- Genotype 6: Primarily found in Southeast Asia
- Genotype 7: Newly identified, rare variant
Modern direct-acting antiviral treatments can cure most genotypes with similar effectiveness, but your doctor may select specific medications based on your genotype.
Hepatitis C Complications
Without treatment, chronic hepatitis C can lead to serious health complications:
- Fibrosis – Mild to moderate liver scarring
- Develops gradually over years of inflammation
- May be reversible with treatment and lifestyle changes
- Cirrhosis – Severe liver scarring
- Develops in 10-20% of people with chronic HCV after 20-30 years
- Can cause liver failure and other complications
- May be partially reversible in early stages with treatment
- Hepatocellular Carcinoma (HCC) – Primary liver cancer
- Annual risk of 1-4% in people with HCV-related cirrhosis
- Often detected late, making treatment more difficult
- Regular screening recommended for those with cirrhosis
- Liver Failure – Inability of the liver to function properly
- May require liver transplantation
- Life-threatening condition
- Can develop gradually or suddenly
- Cryoglobulinemia – Blood protein abnormalities causing vasculitis
- Glomerulonephritis – Kidney inflammation
- Porphyria cutanea tarda – Skin blistering condition
- Diabetes and insulin resistance
- Lymphomas – Cancers of the lymphatic system
- Autoimmune disorders
- Cardiovascular disease
- Cognitive impairment
Diagnosing hepatitis C typically involves a two-step testing process:
Initial Screening Test:
- Hepatitis C Antibody Test: Detects antibodies produced in response to HCV infection
- A positive result means you have been exposed to the virus at some point
- Does not distinguish between past (resolved) and current infection
- Takes 2-3 months after infection for antibodies to develop (window period)
Confirmatory Testing:
- HCV RNA Test (viral load): Directly detects the genetic material of the virus
- Confirms current infection
- Can detect the virus 1-2 weeks after infection
- Measures the amount of virus in the bloodstream
- Used to monitor treatment response
Additional Tests:
- Genotype Testing: Determines the specific strain of HCV
- Liver Function Tests: Assess liver damage
- Liver Fibrosis Assessment:
- FibroScan (elastography): Non-invasive measurement of liver stiffness
- FibroTest or other blood test panels
- Liver biopsy: Taking a small sample of liver tissue (less commonly used now)
- Imaging Tests: Ultrasound, CT scan, or MRI to check for liver damage or cancer
Since there is no vaccine for hepatitis C, prevention focuses on reducing exposure risk:
- Never share needles, syringes, or any drug preparation equipment
- Avoid sharing personal items that might have blood on them (razors, toothbrushes)
- Choose licensed tattoo and piercing facilities that use sterile equipment
- Use condoms during sex, especially with new partners or in high-risk situations
- Healthcare workers should follow standard precautions and safe injection practices
- Get tested if you:
- Were born between 1945-1965
- Have ever injected drugs
- Received blood products before 1992
- Have HIV
- Were born to a mother with HCV
- Have abnormal liver tests or liver disease
The Biology of Hepatitis C Virus
The hepatitis C virus has several unique characteristics:
- Member of the Flaviviridae family
- Single-stranded RNA virus with an envelope
- Extremely variable genome with a high mutation rate
- Six major genotypes with over 50 subtypes
- Replicates primarily in liver cells (hepatocytes)
- Uses an enzyme called RNA-dependent RNA polymerase that lacks “proofreading” ability, leading to frequent mutations
- Does not integrate into the host DNA (unlike HIV or HBV)
- Can establish persistent infection by evading immune responses
- Rapidly produces viral particles – up to one trillion per day in an infected person
Hepatitis C Treatment
Hepatitis C treatment has been revolutionized in recent years with the development of direct-acting antivirals (DAAs):
-
Current Treatment Options
-
Treatment Considerations
-
What to Expect During Treatment
- Direct-Acting Antivirals (DAAs):
- Cure rates of over 95% with 8-12 weeks of treatment
- Few side effects compared to older treatments
- Oral medications (pills), no injections needed
- Examples include: Epclusa, Mavyret, Harvoni, Zepatier, Vosevi
- Duration: Typically 8-12 weeks, sometimes up to 24 weeks
- Genotype: Some treatments work for all genotypes, others are genotype-specific
- Prior treatment history: Different options for treatment-experienced patients
- Cirrhosis status: May affect treatment choice and duration
- Drug interactions: Some medications cannot be taken with DAAs
- Insurance coverage: Sometimes restricted due to high cost of medications
- Regular medical visits to monitor treatment response
- Blood tests to check viral load and liver function
- Few side effects – may include headache, fatigue, nausea
- Continued abstinence from alcohol recommended
- Avoiding certain medications that may interact with treatment
Hepatitis C Risk Factors
Certain factors increase the risk of contracting hepatitis C:
- Current or former injection drug use (accounts for most new infections)
- Receiving blood transfusions or organ transplants before 1992
- Receiving clotting factor concentrates before 1987
- Long-term hemodialysis
- Needle stick injuries in healthcare settings
- Being born to a mother with hepatitis C
- Incarceration
- Unregulated tattoos or piercings
- Intranasal drug use (sharing straws or other equipment)
- HIV infection
- Being born between 1945-1965 (baby boomers)
- Having received healthcare in countries with high HCV prevalence
Living with Hepatitis C
For those diagnosed with hepatitis C, several steps can help manage the condition:
- Get appropriate medical care and attend all follow-up appointments
- Avoid alcohol, which can accelerate liver damage
- Talk to your doctor before taking any medications or supplements
- Get vaccinated against hepatitis A and B to prevent additional liver damage
- Maintain a healthy weight and eat a balanced diet
- Exercise regularly as appropriate for your condition
- Manage stress through relaxation techniques
- Join a support group to connect with others with hepatitis C
- Disclose your status to sexual partners and healthcare providers
Avoid sharing personal items that might have blood on them
Hepatitis C Facts and Statistics
- Baby boomers are 5 times more likely to have hepatitis C than other adults
- Treatment success rates have improved from 40% to over 95% since 2013
- Hepatitis C is the leading cause of liver transplantation in the U.S.
- About 1 in 30 baby boomers has hepatitis C
- The cost of new treatments has declined dramatically since their introduction
- Many states have restrictions on which Medicaid patients can receive treatment
- Hepatitis C-related mortality exceeded HIV-related mortality in the U.S. since 2007
- Hepatitis C can remain viable on surfaces at room temperature for up to 3 weeks
- The U.S. has a goal to eliminate viral hepatitis as a public health threat by 2030
Frequently Asked Questions About Hepatitis C
Yes, with modern direct-acting antivirals, hepatitis C is curable in more than 95% of people who complete treatment. Cure means the virus is not detectable in the blood 12 weeks after finishing treatment.
Yes, being cured of hepatitis C doesn’t provide immunity. If you’re exposed to the virus again, you can become reinfected.
Many people with hepatitis C have no symptoms for 20-30 years. The infection is often discovered during routine blood tests or when complications develop.
Hepatitis C is contagious, but only through blood-to-blood contact. It’s not spread through casual contact like hugging, sharing food, or sneezing.
No, there is currently no vaccine for hepatitis C. Research to develop one is ongoing, but the high variability of the virus makes vaccine development challenging.
If you’ve been cured of hepatitis C (achieved SVR), some blood banks may accept your donation. However, policies vary, so check with your local blood donation center.
The CDC recommends that people who inject drugs get tested regularly, at least annually. Others with ongoing risk factors should discuss testing frequency with their healthcare provider.
Not everyone with chronic hepatitis C will develop serious liver damage. However, without treatment, 10-20% will develop cirrhosis within 20-30 years.
Alcohol should be avoided completely by people with hepatitis C, as it accelerates liver damage and reduces the effectiveness of treatment.
Learn More About Hepatitis C Testing
If you’re concerned about hepatitis C or want to get tested, call (866) 566-8711 to speak with a care advisor who can help you understand your testing options.
LocalSTDTesting is not a substitute for professional medical advice, diagnosis, or treatment.
Always seek the advice of your physician with any questions about medical conditions.
