Hepatitis C

What Is Hepatitis C?

Hepatitis C is an infection of the liver caused by the hepatitis C virus (HCV). HCV can lead to liver failure, liver cancer, or chronic liver disease (cirrhosis), and is a leading reason for liver transplants in the United States.

Some people with HCV have just a short-term illness because their bodies can get rid of the virus. But most infected people (70%–85%) develop a chronic HCV infection.

How Do People Get Hepatitis C?

HCV spreads by direct contact with an infected person's blood and other body fluids. This can happen through:

• sharing drug needles and intranasal (snorting) drug devices
• getting a tattoo or body piercing with unsterilized tools
• sexual contact (although this is less common)
• passing of the infection from a pregnant woman to her unborn child

Children who have HCV most often acquired it as newborns from their mothers.

Thanks to blood screening and other health care precautions adopted in the early 1990s, the spread of HCV from hemodialysis, blood transfusions, or organ transplants is now rare.

It's also rare, but possible, for someone to get HCV by sharing household items that might contain an infected person's blood, such as razors, toothbrushes, or scissors.

Who Is at Risk for Hepatitis C?

HCV is more common in adults than in children. Rates of HCV infection in the United States almost tripled from 2010 to 2015, according to the Centers for Disease Control and Prevention (CDC). Most of these new infections are in young people (20 to 29 years old) who inject drugs — many of whom moved from abusing prescription pain relievers (opioids) to injecting heroin, which often is cheaper and easier to get.

Because women of reproductive age are part of this group, experts worry that more newborns will be at risk for HCV.

What Is Chronic Hepatitis C?

Doctors refer to hepatitis C infections as either acute or chronic:

• An acute HCV infection is a short-term illness that clears within 6 months of when a person is exposed to the virus.
• A person who still has HCV after 6 months is said to have a chronic hepatitis C infection. This is a long-term illness, meaning the virus stays in the body and can cause lifelong illness. An estimated 3.2 million people in the U.S. have chronic HCV.

What Are the Signs & Symptoms of HCV Infection?

Hepatitis C can be a "silent but deadly" infection. Most people with HCV have no symptoms. But even without symptoms, they can develop health problems decades later and can still pass the disease to others.

When symptoms do happen (usually when the disease is very advanced), they can be similar to those of hepatitis A and hepatitis B and include:

• jaundice (when the skin and whites of the eyes look yellow)
• fever
• nausea, vomiting, and lack of appetite
• belly pain (on the upper right side)
• joint pain
• darker than usual urine (pee) or gray-colored stools

What Problems Can Hepatitis C Cause?

Hepatitis C is the most serious type of hepatitis. It's now one of the most common reasons for liver transplants in adults. Every year, more people in the United States die from HCV than from 60 other infectious diseases — including HIV, pneumococcal pneumonia, and tuberculosis — combined.

Fortunately, medicines can now treat people with hepatitis C and cure them in most cases.

How Is Hepatitis C Diagnosed?

Doctors do a blood test (the hepatitis C antibody test) to look for antibodies to hepatitis C. If antibodies are present, it only means that the person has had an HCV infection at some point. To see if the disease is still active, doctors do another test (RNA test) to measure the level of HCV (the viral load) in the blood.

The CDC recommends the diagnostic blood test for:

• all Americans born between 1945–1965 (baby boomers)
• anyone who has ever injected drugs
• patients who received donated blood or organs before 1992
• people receiving hemodialysis
• people who have conditions such as HIV or chronic liver disease
• newborns born to mothers with HCV
• people exposed to the blood of someone with HCV

How Is Hepatitis C Treated?

Significant progress has been made in treating and even curing hepatitis C. Older hepatitis C treatments usually required weekly injections, had serious side effects, and often were not effective.

New and better oral medicines now can cure HCV for many people within 3 months. The new medicines were very expensive at first, but their prices have come down, a trend that health experts hope will continue as the incidence of HCV rises and increased screening brings more cases to light.

These medicines successfully cure about 90% of HCV patients. A new oral medicine under development looks promising for the 10% who don't respond to the standard treatment. This new antiviral combination pill is currently under review by the U.S. Food and Drug Administration (FDA).

What Happens After a Hepatitis C Infection?

As with hepatitis B, anyone who has ever tested positive for hepatitis C cannot be a blood donor.

Health experts caution that people who had HCV associated with drug use should get counseling or further treatment to help them overcome their addiction. Otherwise, they could become reinfected with HCV.

Can Hepatitis C Be Prevented?

Unfortunately, there's no vaccine to protect against hepatitis C. Prevention means avoiding risky behaviors that can spread HCV, especially injecting drugs.