Hepatitis C and the Hep C Virus

Medically Reviewed by Jabeen Begum, MD on September 04, 2024
Written by Lori M. King, PhD
11 min read

Hepatitis C is liver inflammation and damage caused by infection with the hepatitis C virus. Hep C can cause a mild illness that lasts a short time (acute) or a serious illness that can last the rest of your life (chronic).

You generally get infected with the hep C virus when you come into contact with the blood — even a tiny amount — from a person who is infected. Most of the people who are infected with hep C in the U.S. probably got it from sharing needles and syringes used to inject drugs. You can be infected with hep C and not know it because you may not look or feel sick at first. Most people won't have any symptoms until about 2 weeks to 6 months after they are infected.

Hepatitis C is one of the most common viral causes of hepatitis in the U.S. Between 2.4 and 4 million people had it in 2017-2020. Read on to learn more about how it's spread, the symptoms, and treatment options.

Most people won't notice they have been infected with the hepatitis C virus because they either don't have any symptoms or only get them many weeks later. A hepatitis C infection may go through several stages, including:

Incubation period

This is the time between when you are first exposed to hep C and the start of your symptoms. During this time, the virus is reproducing itself inside your cells. It'll keep doing this until the levels of virus in your body get high enough for your immune system to recognize it as an infection. This period can last from 2 weeks to 6 months.

Acute hepatitis C

This is when you may start to notice symptoms if you have them. Only about 20% of people will have symptoms. This can last up to 3 months. Some people can fight off the virus during this time without needing any treatment.

Chronic hepatitis C

Most people (about 80%) can't fight off the virus without treatment. In this case, you will develop chronic hepatitis C. Hep C infection causes inflammation in your liver that will eventually lead to damage and permanent scarring (cirrhosis). Cirrhosis of the liver is a serious condition that can get worse over time.

You get infected with the hepatitis C virus when you come into contact with the blood of someone else who is infected. It doesn't take much blood; even a drop has enough virus in it to infect you.

Most people come into contact with the blood of an infected person when they:

  • Share needles, syringes, or other materials you use for drugs you inject in your veins (this is the most common way in the U.S.) 
  • Work in a health care setting and are stuck by an infected needle
  • Have a tattoo or piercing done with unsterilized equipment
  • Have contact with the blood or open sores of a person who is infected
  • Share personal care or medical items that may have contacted someone else's blood, such as toothbrushes, razor blades, nail clippers, and glucose monitors 
  • Have sex with an infected partner, especially if you don't use a condom
  • Are born to a mother who is infected when she gives birth

Hep C only spreads through contact with blood, not spit, breast milk, or semen. So, you can’t catch hepatitis C through:

  • Being coughed or sneezed on by an infected person
  • Sharing food, drinks, or eating utensils
  • Casual contact, such as sitting next to, shaking hands with, holding hands with, or hugging another person
  • Kissing another person
  • Nursing an infant (unless your nipples are cracked and bleeding)
  • Mosquito bites

Many people (about 80%) who are infected with hepatitis C have no symptoms. This means they can't tell that they're infected. If you do get symptoms, they usually won't show up until 2 weeks to 6 months after you're infected. 

If you think you may have been infected with hep C, look for the following symptoms:

  • Fatigue, feeling more tired than usual or so tired you can't function
  • Fever
  • Loss of appetite
  • Nausea and vomiting
  • Belly pain
  • Dark yellow pee and clay-colored (pale beige or gray) poop
  • Joint pain
  • Jaundice, when your skin, the whites of your eyes, and your mucous membranes turn yellow

You may not have all of these, but if you have a few of them, you should go see your doctor for a checkup.

If you have chronic hepatitis C, you probably won't notice any symptoms until you start to have complications from liver damage. Liver damage is the cause of cirrhosis of the liver, which is when most of your healthy liver tissue has been replaced with scar tissue. When this happens, your liver can't function very well. This process can take 10-30 years. This is why it's important for you to get screened for hepatitis C infection by your doctor.

If you have chronic hepatitis C, you may start to notice the following symptoms when your liver function declines:

  • Loss of appetite
  • Nausea
  • Fatigue
  • Feeling generally unwell (your doctor may call this malaise)
  • Pain in your upper belly, especially on your right side, under your ribs
  • Spider-like veins on your skin (spider angiomas)
  • Redness in the palms of your hands (palmar erythema)

As your liver function continues to decline, you may notice the following:

  • Jaundice
  • Itchy skin but without any visible rash
  • Dark yellow pee and clay-colored poop
  • Trouble digesting food, especially when you eat fatty foods
  • Yellow bumps on your skin, especially around your eyes
  • Losing weight without trying and losing muscle
  • Confusion, disorientation, and mood changes
  • Twitching, tremors, inability to control your muscles temporarily
  • Changes in your menstrual cycle
  • Enlarged breast tissue and shrunken testicles in people who are assigned male at birth (AMAB)
  • Swelling in your belly (ascites)
  • Swelling in your hands, feet, legs, and face (edema)
  • Easy bleeding and bruising
  • Blood in your vomit or poop
  • Low volume when you pee
  • Shortness of breath

The CDC recommends hepatitis C testing on the following schedules:

  • Get screened at least once in your lifetime if you're 18 or older.
  • Get screened during each pregnancy.

Get tested at least once if you:

  • Ever injected drugs or currently do. Get tested regularly if you inject drugs and share needles, syringes, or other drug equipment.
  • Have HIV.
  • Have abnormal liver tests, liver disease, or are on kidney dialysis.
  • Had a blood transfusion or an organ transplant before July 1992.
  • Received a blood product used to treat clotting problems before 1987.
  • Work in health care, emergency medical services, or public safety where you could be exposed to needle sticks, sharps, or mucosal exposure to the hepatitis C virus.
  • Were born to a mother with hepatitis C.

Since July 1992, all blood and organ donations in the U.S. are tested for the hepatitis C virus. The CDC says it is now rare that someone getting blood products or an organ would get hepatitis C. That said, the CDC recommends that anyone over the age of 18 get tested for Hepatitis C. If you haven't been screened, you should consider having it done.

Your doctor will likely start by checking your blood for:

Anti-HCV antibodies. These are proteins your body makes when it finds the hep C virus in your blood. They usually show up about 12 weeks after infection.

It usually takes a few days to a week to get results, though a rapid test (with results ready in about 30 minutes) is available in some places.

Your results may include:

  • Nonreactive (negative). This means you're not currently infected with hep C. If you think you've been exposed within the last 6 months, you will need to be tested again to make sure because it can take a while for your antibody levels to rise high enough to be detected on a test.
  • Reactive (positive). This means that you have been infected with hep C at some point, but you may not be currently infected. Your immune system may have fought off the virus on its own without treatment. If you're positive or think you've been exposed to the hep C virus within in past 6 months, your doctor will order a test called a qualitative nucleic acid test (NAT) to look for the virus currently in your blood. This measures the number of viral RNA (genetic material from the hepatitis virus) particles in your blood. They usually show up 1-2 weeks after you’re infected.

Genotype testing

If you have hepatitis C and need treatment, your doctor may test for what type or strain of hepatitis C virus you're infected with. There are seven different strains of the hep C virus. Genotype 1 is the most common strain in the U.S. The strain you have may determine what treatment your doctor recommends.

Because hepatitis C can damage your liver, your doctor may also do some tests to determine if you have liver damage, including:

Liver function tests. These measure your liver protein and enzyme levels, which usually rise 7 to 8 weeks after you’re infected. As your liver becomes more damaged over time, enzymes will leak into your bloodstream.

Transient elastography. This is an ultrasound or MRI of your liver to assess how much scarring you have in your liver.

Liver biopsy. You usually won't need this, but you may get it if your other tests don't give your doctor enough information. Your doctor can usually use a syringe and needle to remove small pieces of tissue from your liver.

If you have an acute infection, your doctor may wait to see if your immune system will fight it off on its own before treating you. But if you're currently positive for hepatitis C virus, talk to your doctor about treatment as soon as possible. In most cases (95% of the time), treatment with an antiviral medicine can cure the infection in about 8-12 weeks. This can keep you from getting long-term liver damage.

You and your doctor will figure out the best therapy and how long you’ll need to take it based on a few things. These include:

  • The genotype of hepatitis C you're infected with
  • The condition of your liver
  • Other health problems you may have

If you have chronic hepatitis C infection, your doctor may prescribe any of the following direct-acting antiviral (DAA) medicines: 

  • Daclatasvir (Daklinza)
  • Elbasvir-grazoprevir (Zepatier)
  • Glecaprevir/pibrentasvir (Mavyret)
  • Ledipasvir/sofosbuvir (Harvoni)
  • Ombitasvir/paritaprevir/ritonavir (Technivie)
  • Ombitasvir/paritaprevir/ritonavir/dasabuvir (Viekira Pak)
  • Simeprevir (Olysio)
  • Sofosbuvir (Sovaldi)
  • Sofosbuvir/velpatasvir (Epclusa)
  • Sofosbuvir/velpatasvir/voxilaprevir (Vosevi)

You may also get a prescription for one of these older medicines along with your DAA medicine:

  • Ribavirin. This is an antiviral in the nucleoside analog class. You may get this to take along with peginterferon alfa-2a (Pegasys) or peginterferon alfa-2b (PEG-Intron).
  • Peginterferon alfa-2a (Pegasys). This is a medicine that acts like a protein your immune system makes. It's used to treat both hepatitis B and C by reducing the amount of virus in your body.
  • Peginterferon alfa-2b (PEG-Intron). This is another medicine that acts like a protein your immune system makes. It's used mainly to treat hepatitis C.

Your side effects will depend on the medicine you take. The most common side effects of antiviral medicines include:

  • Diarrhea
  • Headache
  • Nausea
  • Fatigue
  • Sleep problems (trouble falling asleep or staying asleep)
  • Signs of liver injury, such as right upper belly pain, loss of appetite, nausea, dark pee, light-colored poop, yellowing of the skin and eyes, unusual weakness or fatigue

As with many medicines, you may have an allergic reaction to antiviral medicines, such as skin rash, itching, hives, or swelling of your face, lips, and tongue. This can develop into a life-threatening reaction very fast, so go to the ER as soon as possible.

About 75%-85% of people who are infected with hepatitis C, develop chronic hepatitis C. If you don't get treatment, you may develop:

Cirrhosis, or scarring of the liver. This is a process during which your healthy liver tissue is replaced with scar tissue. As scar tissue builds up, your liver may begin to fail.

Liver failure (end-stage liver disease). This can take months or years. As scar tissue builds up in your liver, it will get to a point where it can't replace any damaged cells and may stop functioning completely.

Liver cancer. Chronic hepatitis C increases your chance of developing liver cancer. If you develop cirrhosis, you'll still be at an increased risk for liver cancer, even if you have treatment and are cured. Your doctor will likely recommend you have blood tests and liver ultrasounds periodically to check for signs of liver cancer.

 

When you visit the doctor, you may want to ask questions to get the information that you need to manage your hepatitis C. If you can, have a family member or friend take notes. You might ask:

  1. What kinds of tests will I need?
  2. Are there any medications that might help?
  3. What are the side effects of the medications you might prescribe?
  4. How do I know when I should call the doctor?
  5. How much exercise can I get, and is it all right to have sex?
  6. Which drugs should I avoid?
  7. What can I do to prevent the disease from getting worse?
  8. How can I avoid spreading hepatitis C to others?
  9. Are my family members at risk for hepatitis C?
  10. Should I be vaccinated against other types of hepatitis?
  11. How will you keep tabs on the condition of my liver?

There’s currently no vaccine to prevent hepatitis C. Here are the best ways to avoid getting hep C:

  • Don't share needles, syringes, or other equipment when injecting drugs.
  • Protect yourself by wearing gloves if you must touch another person's blood or open sores.
  • If you're getting a tattoo or piercing, make sure the shop you visit uses sterile tools and unopened ink.
  • Don't share personal items such as razors, toothbrushes, or nail clippers.
  • Use a condom every time you have sex.

Yes, hepatitis C can be cured in most people with a direct-acting antiviral (DAA) medication.

About 12 weeks after your treatment ends, your doctor will test your blood to make sure the virus is gone. If it is, that’s called a sustained virologic response, which means you're cured. If you’re not cured, your doctor may suggest trying again with a different DAA drug regimen.
 

Hepatitis C is liver inflammation and damage caused by an infection with the hepatitis C virus. Many people have the virus without realizing it, as it doesn't always cause symptoms. It spreads when you come into contact with the blood of a person who is infected. You may develop chronic hepatitis C, which may lead to complications, such as cirrhosis of the liver and liver failure. But with DAA medicines, about 95% of people can be cured. After treatment, make sure you follow the healthy habits your doctor has suggested and go for all of your follow-up tests.

What is the main cause of hepatitis C?

Hepatitis C is caused by infection with the hep C virus. In the U.S., most people are exposed to the hepatitis C virus by sharing needles, syringes, and other equipment used to inject drugs.

Can your liver heal from hepatitis C?

Yes, your liver should be able to heal itself once you've gotten treatment — unless you've developed cirrhosis of the liver. Cirrhosis is irreversible, but if you stop the damage to your liver, you may be able to slow or stop it from advancing further. If you have chronic hepatitis C, you are at risk of developing cirrhosis. See your doctor for treatment.

Is hepatitis B or C worse?

Both hepatitis B and C infections can cause liver damage. Hepatitis B is more prevalent and can be passed through blood or sexual contact, so it's easier to become infected with hepatitis B. However, hepatitis C is more likely to develop into a chronic condition, which puts you at risk for cirrhosis and liver cancer. Also, many people don't know they have hepatitis C because it doesn't always cause symptoms. In that respect, hepatitis C may be worse because although it's easy to cure, it may cause serious complications if you don't know you have it.

Print
View privacy policy, copyright and trust info
View privacy policy, copyright and trust info