Hepatitis C

Overview

Hepatitis C is a viral infection that causes liver swelling, called inflammation. Hepatitis C can lead to serious liver damage. The hepatitis C virus (HCV) spreads through contact with blood that has the virus in it.

Newer antiviral medicines are the treatment of choice for most people with the ongoing, called chronic, hepatitis C infection. These medicines often can cure chronic hepatitis C.

But many people with hepatitis C don't know they have it. That's mainly because symptoms can take decades to appear. So, the U.S. Preventive Services Task Force recommends that all adults ages 18 to 79 years be screened for hepatitis C.

Screening is for everyone, even those who don't have symptoms or known liver disease.

Symptoms

Every long-term hepatitis C infection starts with what's called an acute phase. Acute hepatitis C usually isn't diagnosed because it rarely causes symptoms. When there are symptoms in this phase, they may include jaundice, fatigue, nausea, fever and muscle aches.

Long-term infection with the hepatitis C virus is called chronic hepatitis C. Chronic hepatitis C usually has no symptoms for many years. Symptoms appear only after the virus damages the liver enough to cause them.

Symptoms can include:

• Bleeding easily.
• Bruising easily.
• Fatigue.
• Not wanting to eat.
• Yellowing of the skin, called jaundice. This might show up more in white people. Also, yellowing of the whites of the eyes in white, Black and brown people.
• Dark-colored urine.
• Itchy skin.
• Fluid buildup in the stomach area, called ascites.
• Swelling in the legs.
• Weight loss.
• Confusion, drowsiness and slurred speech, called hepatic encephalopathy.
• Spiderlike blood vessels on the skin, called spider angiomas.

Acute hepatitis C infection doesn't always become chronic. Some people clear the infection from their bodies after the acute phase. This is called spontaneous viral clearance. Antiviral therapy also helps clear acute hepatitis C.

Causes

Hepatitis C infection is caused by the hepatitis C virus (HCV). The infection spreads when blood that has the virus enters the bloodstream of a person who isn't affected.

Around the world, hepatitis C infection exists in several forms, called genotypes. There are seven genotypes and 67 subtypes. The most common hepatitis C genotype in the United States is type 1.

Chronic hepatitis C follows the same course no matter what the genotype of the infecting virus. But treatment can vary depending on viral genotype. However, newer antiviral drugs can treat many genotypes.

Risk factors

Screening for hepatitis C

The U.S. Preventive Services Task Force recommends that all adults ages 18 to 79 years be screened for hepatitis C. Screening is very important for people at high risk of exposure. This includes:

• Anyone who has ever injected, snorted or inhaled an illegal drug.
• Anyone who has atypical liver test results in which the cause wasn't found.
• Babies born from someone who has hepatitis C.
• Pregnant people during the pregnancy.
• Health care and emergency workers who have been in contact with blood or been stuck by a needle.
• People with hemophilia who were treated with clotting factors before 1987.
• People who have had long-term hemodialysis.
• People who got donated blood or organ transplants before 1992.
• Sexual partners of anyone diagnosed with hepatitis C infection.
• People with HIV infection.
• Men who have sex with men.
• Sexually active people about to start taking medicine to prevent HIV, called pre-exposure prophylaxis or PrEP.
• Anyone who has been in prison.

Complications

Hepatitis C infection that continues over many years can cause serious complications, such as:

• Scarring of the liver, called cirrhosis. Scarring can occur after decades of hepatitis C infection. Liver scarring makes it hard for the liver to work.
• Liver cancer. A small number of people with hepatitis C infection get liver cancer.
• Liver failure. A lot of scarring can cause the liver to stop working.

Prevention

The following might protect from hepatitis C infection:

• Stop using illegal drugs. If you use illegal drugs, seek help.
• Be careful about body piercing and tattooing. For piercing or tattooing, look for a shop that's known to be clean. Ask questions about how the equipment is cleaned. Make sure the employees use sterile needles. If employees won't answer questions, look for another shop.
• Practice safer sex. Don't have sex without protection with any partner whose health status you don't know. Don't have sex with more than one partner. The risk of couples who only have sex with each other getting hepatitis C through sex is low.

Diagnosis

If a screening test shows hepatitis C, other blood tests can:

• Measure the quantity of the hepatitis C virus in the blood, called the viral load.
• Show the genotype of the virus.

Tests for liver damage

One or more of the following tests looks for liver damage in chronic hepatitis C.

• Magnetic resonance elastography (MRE). This noninvasive imaging can be done instead of a liver biopsy. It mixes magnetic resonance imaging technology with patterns formed by sound waves bouncing off the liver. This makes a map that shows places where the liver is stiff. Stiff liver tissue means scarring of the liver, called fibrosis.
• Transient elastography. Another test of liver stiffness is a type of ultrasound that sends vibrations into the liver. The test measures how fast the vibrations go through liver tissue.
• Liver biopsy. This is often done using ultrasound as a guide. It involves putting a thin needle into the liver to remove a small sample of liver tissue to be tested in a lab.
• Blood tests. A series of blood tests can show the amount of scarring in the liver.

Treatment

Antiviral medicines

Antiviral medicines treat hepatitis C. They're used to clear the virus from the body. The goal of treatment is to have no hepatitis C virus found in the body for at least 12 weeks after treatment ends.

Some newer antiviral medicines, called direct-acting, have better outcomes, fewer side effects and shorter treatment times. Treatment can be as short as eight weeks. The choice of medicines and length of treatment depend on the hepatitis C genotype, whether the liver is damaged, other medical conditions and earlier treatments.

Throughout treatment, the care team watches the treatment for response to the medicines and side effects. Treatment with direct-acting antiviral medicines usually lasts 12 weeks.

Due to the pace of research, treatments are changing quickly. So it's best to discuss treatment choices with a specialist.

Liver transplantation

Having a liver transplant might be an option for serious liver damage from chronic hepatitis C infection. During a liver transplant, a surgeon removes the damaged liver and replaces it with a healthy liver. Most transplanted livers come from dead donors. A small number come from living donors who donate a part of their livers.

In most cases, a liver transplant alone doesn't cure hepatitis C. The infection is likely to return. This means more treatment with antiviral medicines to prevent damage to the new liver. Several studies have shown that newer antiviral medicines cure hepatitis C after a transplant. Sometimes, the newer antivirals can cure hepatitis C before a liver transplant.

Vaccinations

There's no vaccine for hepatitis C. But a health care provider will likely recommend vaccines against the hepatitis A and B viruses. These are viruses that also can cause liver damage and make hepatitis C worse.

Lifestyle and home remedies

Certain lifestyle changes can help manage hepatitis C. These measures can help keep you healthy longer and protect the health of others:

• Stop drinking alcohol. Alcohol speeds liver disease.
• Don't use medicines that might cause liver damage. Review all medicines you take with your health care provider. You might need to not take certain medicines.

• Keep others from coming in contact with your blood. Cover wounds you have. Don't share razors or toothbrushes. Don't donate blood, body organs or semen. Tell health care workers that you have the virus.

  Tell your partner about your infection before you have sex. Always use condoms during intercourse.

Preparing for an appointment

If you think you might be at risk of hepatitis C, see your health care provider. If you're diagnosed with a hepatitis C infection, your provider might refer you to a specialist in liver diseases, called a hepatologist, or a specialist in infectious diseases.

What you can do

Consider taking a family member or friend with you to the appointment to help you remember the information you get.

Make a list of:

• Your test results. If you're seeing a liver specialist for the first time after being diagnosed with hepatitis C, write down the results of tests you've had. This includes a liver biopsy to check for damage from chronic infection and a blood test to find which hepatitis C genotype you have.
• Your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment, and when they began.
• All medicines, vitamins and supplements you take, including doses.
• Questions to ask your health care provider.

Some basic questions to ask about hepatitis C include:

• Should I be tested for other causes of liver disease, such as hepatitis B?
• Has the hepatitis C virus damaged my liver?
• Do I need treatment for a hepatitis C infection?
• What are my treatment choices?
• What are the pros of each treatment option?
• What are the potential risks of each treatment option?
• Is there one treatment you think is best for me?
• I have other medical conditions. How will these affect my hepatitis C treatment?
• Should my family be tested for hepatitis C?
• Is it possible for me to spread the hepatitis C virus to others?
• How can I protect the people around me from hepatitis C?
• Are there brochures or other material that I can have? What websites do you recommend?
• What will decide whether I should plan for a follow-up visit?
• Is it safe for me to drink alcohol?
• What medicines should I avoid?

Be sure to ask all the questions you have about your condition.

What to expect from your doctor

Your health care provider is likely to ask you questions, such as:

• Have you ever gotten donated blood or an organ transplant? If so, when?
• Have you ever given yourself shots of illegal drugs?
• Have you been diagnosed with hepatitis or jaundice?
• Does anyone in your family have hepatitis C?
• Is there a history of liver disease in your family?