Hepatitis C is a severe liver infection. Also known as HCV or hep C, it starts as a short-term infection with the hepatitis C virus. More than half of people infected with hep C develop a lifelong infection. Lifelong infection is most likely to happen to people who do not receive treatment before the disease progresses.
Many people with hep C don't know they have it. That's why all adults should get a hepatitis C test at least once in their life.
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What Is Hepatitis C?
Hepatitis C is a liver disease caused by the hepatitis C virus (HCV), which is carried in the blood of infected people.
According to various estimates, anywhere from 3 to 10 million people in the United States are carriers of the virus. One reason for this estimate range is that the virus wasn't even diagnosed until the late 1980s. Most carriers of hep C are still unaware of their HCV status.
Hepatitis C is serious for some people, but not for others. Most people who get hepatitis C carry the virus for the rest of their lives. The majority will experience some liver damage but may not feel sick from the disease.
Some people with liver damage due to hepatitis C may develop cirrhosis (scarring) of the liver and liver failure, which may take many years to develop.
How common is hepatitis C?
According to the American Liver Foundation, about 17,000 new cases of Hep C are diagnosed each year in the U.S. In addition, an estimated 2.7 million to 3.9 million Americans have chronic hepatitis C, with as many as 75% of them unaware that they are infected.
Roughly 15,000 people die from hepatitis C-related liver disease each year, according to the U.S. Centers for Disease Control and Prevention (CDC), exceeding the annual death rate from HIV.
What causes hepatitis C?
Hep C spreads between people when blood from an infected person enters the body of someone who is not infected.
Common ways the virus spreads include:
- Being accidentally stuck by an HCV-infected needle or having frequent contact with HCV-infected people (concerns for health care workers).
- During childbirth if an HCV-infected mother passes HCV onto her newborn.
- Injecting illicit drugs without following safe needle-use behaviors.
- Participating in rough sexual practices with an infected person.
- Receiving an HCV-infected organ transplant.
- Receiving a tattoo, body piercing, or acupuncture with unsterilized or improperly sterilized equipment.
- Receiving HCV-infected blood through transfusion (before 1992) or an infected blood clotting product (before 1987).
- Receiving long-term kidney dialysis treatment (dialysis machines can be tainted with HCV-infected blood).
- Sharing toothbrushes, razors, nail clippers, or other personal hygiene items that have HCV-infected blood on them.
- Sharing a straw when inhaling drugs, such as cocaine, with someone infected by HCV.
HCV cannot spread through:
- The air.
- Breastfeeding.
- Casual social contact.
- Coughing and sneezing.
- Hugging, kissing, or holding hands.
- Sharing food, water, or eating utensils.
- Unbroken skin.
Hepatitis C risk factors
A risk factor is something that increases your chance of getting a disease or condition.
Some people face an increased risk of getting HCV, such as those who:
- Are on long-term kidney dialysis treatment.
- Engage in high-risk behaviors like IV drug use, especially with shared needles.
- Have HIV or AIDS.
- Have homemade tattoos or body piercings.
- Have unprotected sex with multiple partners in a short time.
- Have sex with partners who have other sexually transmitted diseases.
- Received blood transfusions before 1992.
- Received blood-clotting products before 1987.
- Were born between 1945 and 1965.
Complications of hepatitis C
Left undiagnosed or untreated, hepatitis can cause serious, even fatal, complications such as:
- Cirrhosis or hardening of the liver.
- Chronic hep C.
- Kidney damage.
- Liver cancer.
- Liver failure.
Within about 20 years of exposure, approximately 20% of people develop cirrhosis, which leads to end-stage liver disease. Alcohol use can dramatically speed the onset of cirrhosis.
How can I reduce my risks of hepatitis C?
Hepatitis C virus is spread primarily through contact with infected blood.
Here are some steps you can take to reduce your risk of contracting hepatitis C:
- Avoid sharing personal hygiene products that might have blood on them including razors, toothbrushes, nail clippers, pierced earrings, and more.
- Avoid handling items that may be contaminated by HCV-infected blood.
- Do not inject illicit drugs, especially with shared needles. Seek help to stop using drugs.
- Do not have sex with partners who have sexually transmitted diseases.
- If you're pregnant, allow your ob-gyn to test and treat you.
- Donate your own blood before elective surgery for use if you need a blood transfusion.
- Limit your number of sexual partners.
- Only receive tattoos or piercings from workers who properly sterilize their tools between customers.
- Practice safe sex (using latex condoms) every time or abstain from sex.
If you have hepatitis C, you can prevent the spread of your infection by:
- Getting both hepatitis A and hepatitis B vaccinations.
- Never donating blood or organs for transplant.
- Telling your dentist and doctors before receiving checkups or treatment.
What Are the Signs and Symptoms of Hepatitis C?
While HCV can be detected in blood between one to three weeks after the initial exposure, 80% of people with hepatitis C have no symptoms and go undiagnosed. Within approximately 50 days, most will begin to develop liver cell injury, although they will be asymptomatic (symptom-free).
About 15% of those exposed to HCV will clear their system of the virus within six months. The remaining 85% will develop some level of chronic hepatitis C. Over time, hep C can cause serious liver damage, although the rate of progression can vary significantly from person to person.
Symptoms of hepatitis C include:
- Dark urine.
- Extreme itching.
- Light or clay-colored stools.
- Loss of appetite.
- Nausea.
- Severe fatigue.
- Stomach pain.
- Yellowed skin or eyes, known as jaundice.
And, cigarette smokers may suddenly dislike the taste of cigarettes.
In addition to some of the above symptoms, chronic hepatitis C infection may also cause:
- Loss of appetite.
- Severe fatigue.
- Weakness.
When should I see a doctor about my hepatitis C symptoms?
If you have any of these symptoms, let your primary care provider know immediately.
How Do You Diagnose Hepatitis C?
To diagnose hepatitis C, your doctor will ask about your symptoms and medical history and perform a physical exam. Your doctor will also want to discuss your risk factors for hepatitis C.
Part of what makes hep C so dangerous is that many people don't have symptoms. Or you might have symptoms that go away for a short time.
But liver damage can get worse even without symptoms. Damage can be severe by the time you receive your diagnosis.
Your doctor might order a blood test for you if you have some hep C symptoms. HCV is diagnosed using blood test results.
Blood tests
Certain blood tests can reveal whether you have active hep C or a past infection. Your doctor will order these blood tests if you show symptoms.
But sometimes, people get tested for hepatitis even if they don't have symptoms. The CDC urges all adults to get tested for hep C at least once in their lives.
People should also have a test for hep C if they:
- Are pregnant.
- Get dialysis.
- Inject drugs currently.
- Have ever injected drugs, even if it was just once or many years ago.
- Have HIV.
- Received blood transfusions or had an organ transplant before 1992.
- Received clotting factor products before 1987.
- Were exposed to the blood of a person with hep C.
- Were born to a mother with HCV.
IV drug users and people on dialysis should receive regular hep C testing.
Other tests
After your doctor confirms your diagnosis, you'll need more tests to find out if you have liver damage.
These tests might include:
- FibroScan® — A noninvasive liver ultrasound to see how much fibrosis your liver has.
- Liver biopsy — Surgery to remove a small piece of liver to test it.
How Do You Treat Hepatitis C?
Thanks to recent antiviral drugs, doctors can cure most people of hep C if it is diagnosed early. Your doctor will tailor your treatment to your health and needs.
Medicine to treat hepatitis C
The CDC recommends that doctors use antiviral drugs to treat everyone who has hepatitis C, regardless of how advanced the disease is. While treating a long-term infection won't reverse liver damage, it can prevent further damage.
The newest drugs, known as direct-acting antivirals, have greatly improved treatment options. UPMC doctors — many of whom tested these drugs in clinical trials — are experts at combining them with older medicines.
Today, people often have fewer side effects and better results. Your doctor will create a treatment plan for you based on your health and whether you have liver damage.
Hepatitis C is treated with the following medicines:
- Interferon, given by injection.
- Ribavirin, given orally.
- Combination of interferon and ribavirin.
These medicines may have limited success rates and can cause difficult side effects. Even with treatment, hepatitis C may not clear up within six months.
Over a long period, chronic hepatitis C can cause serious liver damage. In rare cases, a liver transplant may be necessary.
Surgery to treat hepatitis C
If medicine doesn't help treat your advanced hepatitis C, you may need a liver transplant.
If you need a transplant, we'll work closely with liver transplant doctors at UPMC to provide seamless care so you can focus on healing.
Why Choose UPMC's Center for Liver Diseases for Hepatitis C Care?
Our experts have tested many new antiviral medicines for hepatitis C. These new drugs have been game-changers for many people with the disease. We may even see the end of hepatitis C in the next few decades.
We take a team approach to provide the best results for people with chronic hepatitis C.
At UPMC, your care team will include:
- Clinical pharmacologists
- Gastroenterologists
- Hepatologists
- Nurses
- Physician assistants
- Psychiatrists
