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Hepatitis C is a disease
caused by a
virus that infects the
liver. In time, it can lead to cirrhosis, liver cancer, and liver failure.
Many people don't know that they have hepatitis C until they already
have some liver damage. This can take many years. Some people who get hepatitis
C have it for a short time and then get better. This is called acute hepatitis
C. But most people who are infected with the virus go on to develop long-term,
or chronic, hepatitis C.
Although hepatitis C can be very serious,
most people can manage the disease and lead active, full lives.
Hepatitis C is
caused by the hepatitis C virus. It is spread by contact with an infected
You can get hepatitis C if:
In rare cases, a mother with hepatitis C spreads the
virus to her baby at birth, or a health care worker is accidentally exposed to
blood that is infected with hepatitis C.
The risk of getting hepatitis C through sexual contact is very small.1 The risk is
higher if you have many sex
cannot get hepatitis C from casual contact such as
hugging, kissing, sneezing, coughing, or sharing food or drink.
Most people have no
symptoms when they are first infected with the hepatitis C virus. If you do
develop symptoms, they may include:
Most people go on to develop chronic hepatitis C but
still don't have symptoms. This makes it common for people to have hepatitis C
for 15 years or longer before it is diagnosed.
Many people find out by accident that they have the virus. They find out when
their blood is tested before a blood donation or as part of a routine checkup. Often people with hepatitis C have high levels of liver
enzymes in their blood.
If your doctor
thinks you may have hepatitis C, he or she will talk to you about having a
blood test. If the test shows hepatitis C
antibodies, then you have had hepatitis C at some point. A
second test can tell if you still have hepatitis C.
When blood tests
show that you have hepatitis C, you may need a
liver biopsy to see if the virus has caused scarring
in your liver. During a liver biopsy, a doctor will insert a needle between
your ribs to collect a small sample of liver tissue to look at under a
Some people prefer to
find out on their own if they have been exposed to hepatitis C. You can buy a
home test called a Home Access Hepatitis C Check kit at most drugstores. If the
test shows that you have been exposed to the virus in the past, be sure to talk
to your doctor to find out if you have the virus now.
You and your doctor need to
decide if you should take antiviral medicine to treat hepatitis C. It may not
be right for everyone. If your liver damage is mild, you may not need
If you do take medicine, the best treatment is a
combination of medicines that fight infection. The medicines used include peginterferon, ribavirin, and boceprevir or telaprevir.
How well these medicines work depends on how damaged your liver is, how much
virus you have in your liver, and what type of hepatitis C you have.
Taking care of yourself is an important part of the treatment for
hepatitis C. Some people with hepatitis C don't notice a change in the way
they feel. Others feel tired, sick, or depressed. You may feel better if you
exercise and eat healthy foods. To help prevent further liver damage, avoid
alcohol and illegal drugs and certain medicines that can be hard on your
Learning about hepatitis C:
Living with hepatitis C:
Health Tools help you make wise health decisions or take action to improve your health.
Hepatitis C is
a liver disease that is caused by infection with the hepatitis C virus, a virus
that lives in your liver cells.
get hepatitis C from casual contact such as hugging, kissing, sneezing,
coughing, or sharing food or water with someone. You can
get hepatitis C if you come into contact with the blood of someone who has
The most common way to get hepatitis C is by sharing
needles and other equipment (such as cotton, spoons, and water) used to inject
people could get hepatitis C through blood transfusions and organ transplants.
Since 1992, all donated blood and organs are screened for hepatitis C, so it is
now rare to get the virus this way.
In rare cases, a mother with
hepatitis C spreads the virus to her baby at birth, or a health care worker is
accidentally exposed to blood that is infected with hepatitis C.
If you live with someone who has hepatitis C or you
know someone who has hepatitis C, you generally don't need to worry about getting
the disease from that person. You can help protect yourself by not sharing anything that may
have blood on it, such as razors, toothbrushes, and nail clippers.
Most people who are infected
with hepatitis C—even people who have been
infected for a while—usually don't have symptoms.
If symptoms do develop,
they may include:
A hepatitis C infection can cause damage to your liver (cirrhosis). If you develop cirrhosis, you may
Many other health problems are linked with long-term
cirrhosis. For more information, see the topic
Cirrhosis. There also are many
other conditions with similar symptoms, such as other liver infections and liver damage caused by drinking too much alcohol.
period—the time it takes for symptoms to appear after the hepatitis C virus
has entered your body—is from 2 weeks to 6 months. But not all people have symptoms when they are first infected.
You can spread the virus to someone else at any time after you are infected, even if you don't have symptoms.
There are two phases of
hepatitis C. The first form is called acute hepatitis C. It means that you recently became
infected with the virus. The second form is called chronic hepatitis C. It which means that you have had an
infection for more than 6 months.
Right after you are infected with
hepatitis C, you enter the acute
stage. Some people fight off the virus
and never have any liver problems. But up to 85% of people who are
infected will go on to have chronic hepatitis
Most people have no symptoms
right after they have been infected with hepatitis C. Your symptoms may be
the flu. Since any symptoms are likely to go away in a
few weeks, you may not know you have hepatitis C for a long time.
If you have an obvious symptom of hepatitis C, such as
jaundice, or if you know you have been exposed to the
blood of someone who has hepatitis C, you should be
tested for hepatitis C virus infection.
Long-term hepatitis C
often causes tiny scars in your liver. If you have a lot
of these scars, it becomes hard for your liver to work well. About 25% of
people who develop chronic hepatitis C eventually have more serious liver
problems such as
cirrhosis or liver cancer, usually over a period of 20
or more years.3
Certain things may help
predict your risk for severe liver damage, such as how much alcohol you drink and the age when you were infected.
If the infection becomes
so severe that your liver can no longer function (end-stage liver failure),
liver transplant may be the only way to extend your
Certain things may increase
your risk of becoming infected with the
hepatitis C virus. Just because you are at risk for
getting hepatitis C does not mean that you have the virus.
Many people do not know how they became infected with hepatitis C.
You can get hepatitis C from:
Sometimes people get hepatitis C from:
People born from 1945 to 1965 are 5 times more likely to be infected with hepatitis C than people born in other years.4
Call 911 or other emergency services immediately if you have
hepatitis C and you:
Call your doctor if:
The following health professionals can diagnose
The following specialists also can diagnose the disease
and provide further care:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Because many people don't have symptoms, it's common for
people to have hepatitis C for 15 years or longer before it is diagnosed. Many
people don't find out that they have the virus until they are tested for some other reason, such as when donating
blood. Experts recommend that all adults born from 1945 to 1965 should be tested for hepatitis C.4, 5 People in this age group are more likely to have hepatitis C and not know it.
It is important to be tested for hepatitis C if
Before you have
tests, your doctor will probably talk to you about the
pros and cons of testing for hepatitis C so that you
understand what having the virus means.
Your doctor will:
If your doctor
thinks that you may have hepatitis C, he or she may order:
Some people prefer to find out on their own whether they
have been exposed to hepatitis C. In most drugstores you can buy a
home test called the Home Access Hepatitis C Check kit. If test results show
that you have been exposed to the virus, it is important to discuss these
results with your doctor and to find out if you are infected with the virus
To check how well your liver is working, you may have:
If you have a hepatitis C virus test, you may also get tested for
You may or may not receive treatment for
hepatitis C, depending on:
always an option, because the medicines used to treat hepatitis C have serious
side effects, are expensive, and don't work for everyone.
Being diagnosed with
hepatitis C can change your life. You may need help and support to cope with the illness. For more information, see Home Treatment.
people who have acute hepatitis C don't get treated, because they don't know that they
have the virus.
If a person knows that he or she may have been
exposed to the virus—such as a health care worker who is stuck by a
needle—acute hepatitis C can be found early. Most people who are known to
have an acute hepatitis C infection get treated with medicine. In these cases,
treatment may help prevent long-term (chronic) infection,
although there is still some debate over when to begin treatment and how long
to treat acute hepatitis C.6
is common for people to live with hepatitis C for years without knowing they
have it, because they do not have symptoms. So most people diagnosed with
hepatitis C find out that they already have long-term, chronic infection.
your blood tests and liver biopsy show that you have a chronic infection but no
damage to your liver, you may not need treatment. But treatment with a combination of medicines can fight the viral
Whether or not you take medicines to treat
hepatitis C, you will need to have routine blood tests
to help your doctor know how well your liver is working.
Some people who at first decide not to have
treatment later decide they want to have it.
The medicines usually used to
treat hepatitis C are interferons combined with ribavirin plus a protease inhibitor such as boceprevir (Victrelis) or telaprevir (Incivek). They are used for 6 months to a year and help your body get rid of the virus.
Your doctor can help you decide whether
medicines are right for you.
Sometimes you can take different medicine if your
first round of treatment didn't work very well. The decision to try treatment
again is based on several things including how well you tolerated the first treatment and how well the
first round of treatment worked. Talk to your doctor about whether you might try
damage caused by chronic
hepatitis C usually takes 20 or more years to develop.
If your hepatitis C continues to get worse, it can
cause your liver to stop working, a condition called end-stage liver failure.
In this case, a
liver transplant may be the only way to extend your
life. But if you are drinking alcohol, are sharing needles to inject drugs, or
depression or certain other mental illnesses, liver
transplant may not be an option.
Most people with chronic
hepatitis C will not die from the disease. But 1 to 5 out of 100 people with
severe liver damage from chronic
hepatitis C will die because of the virus.7 Even if a liver transplant is done as a last possible
treatment, there can be complications that lead to death. For more information
about decisions to help prepare for death and dying, see the topic
Care at the End of Life.
There is no vaccine for hepatitis C, but there are vaccines for
hepatitis A and
hepatitis B. Your doctor may recommend that you have
these vaccines to help protect you from more liver problems.
Researchers are working
to develop other treatments, including gene therapy and medicines that help
control the immune system.
There is no vaccine to prevent
hepatitis C. But you can reduce your risk of becoming
If you have hepatitis C, you can help prevent spreading it
Breast-feeding mothers who have hepatitis C can continue to
breast-feed their babies, because hepatitis C cannot be spread through breast
milk. If you are breast-feeding, try to avoid having cracked
nipples, which might pose a risk of spreading the virus to your baby.
Some people who have
hepatitis C don't notice a big difference in the way
they feel. Others feel tired, sick, or depressed. The following are steps you
can take at home that may help you feel better both physically and
It is very common to feel tired if you
have hepatitis C. If you feel tired, give yourself permission to do less and
rest more. If possible, ask others to help out around your home or ask your
employer for a shorter or more flexible work schedule.
Exercise if you feel up to it. Aerobic
exercise can help you have more energy and may also improve depression. It is
best to avoid any strenuous activities on the day after you receive
with hepatitis C have a hard time eating. You may have no appetite, feel
nauseated, or have different tastes than you are used to. Even if you don't
feel like eating, it's very important to eat small meals throughout the day.
Some people have nausea in the afternoon. If this happens to you, try to
eat a big, nutritious meal in the morning.
If you have cirrhosis,
it may not be a good idea to eat salty foods or foods that are high in protein.
If you want to know more about which foods to avoid and which foods are good to
eat, ask your doctor about meeting with a
registered dietitian to discuss a healthy eating
One of the most important
jobs of your liver is to break down drugs and alcohol. If you have hepatitis C,
one of the best things you can do is to avoid substances that may harm your
liver, such as alcohol and illegal drugs. If you have cirrhosis, you also may
need to avoid certain medicines.
If you use illegal drugs or
drink alcohol, it is important to stop. Being honest with your doctor about your drug
and alcohol use will help you deal with any substance abuse problems. If you don't feel that you can talk openly with your doctor, you may want to find a
doctor you feel more comfortable with. If you want to stop using drugs or
alcohol and need help to do so, ask your doctor or someone else you trust about
drug and alcohol treatment options.
Because many medicines can
stress your liver, talk to your doctor before you take any prescription or
over-the-counter medicines. This includes herbal
remedies as well.
If you have itchy skin, ask
your doctor about taking nonprescription medicines, such as diphenhydramine
(for example, Benadryl) or chlorpheniramine (for example, Chlor-Trimeton), to
relieve itching. If you do take these medicines, be sure to follow the
instructions and to stop using the medicine if you have any side
You may feel angry
or depressed about having to live with a long-term, serious disease.
You may have a hard time knowing how to tell other people that you have the
virus. It can be helpful to talk with a
social worker or counselor about what having the
disease means to you. You also may want to find a support group for people with
hepatitis C. If you don't have a support group in your area, there are several
on the Internet.
develop in anyone who has a long-term illness. It also can be a side effect of
antiviral medicines for hepatitis C. If you are feeling depressed, talk to your
doctor about antidepressant medicines and/or counseling. For more information,
see the topic
Learning about hepatitis C
may help you feel more in control of the disease. The more you understand, the
better you can make decisions about treatment and lifestyle changes that may
help you feel better, both physically and emotionally.
Most people who are known to have an
acute hepatitis C infection get treated with antiviral medicine. Treatment for acute hepatitis C may help prevent long-term (chronic) infection,
although there is still some debate over when to begin treatment and how long
to treat acute hepatitis C.6
Antiviral medicines also are used
to treat long-term (chronic)
hepatitis C. These medicines can help prevent the
virus from damaging your liver.
Sometimes treatment doesn't permanently lower
the amount of virus in your blood. But some studies have shown that treatment
may still reduce scarring in your liver, which can lower your chances of
developing cirrhosis and liver cancer.9, 10
Medicines to treat
hepatitis C don't work for everyone. Chronic hepatitis C infection is cured or
controlled in about half of the people who are treated with a combination of
peginterferon and ribavirin.13 Treatment works for up to 50 out of 100
people who have genotypes 1 or 4 and up to 80 out of 100 people who have genotype 2 or
3.13 Adding a protease inhibitor (such as boceprevir or telaprevir) to peginterferon/ribavirin therapy controls hepatitis C in up to 88 out of 100 people with genotype 1.14
If you have tried
interferon in the past and didn't get good results, talk to a doctor who is a
liver specialist (hepatologist). He or she will be able to tell
you about new medicines that are producing good results and about experimental medicines that are being developed.
The length of your
treatment depends on what hepatitis C genotype you have. Genotypes 1 and 4 typically
are treated for 1 year. Genotypes 2 and 3 typically are treated for 6 months.
If you have genotype 1 and your viral load does not show signs of improvement
after 3 months of treatment, your treatment may be stopped.
It is important to weigh the benefits of medicines for hepatitis
C against the drawbacks. You most likely don't need to make a quick decision
about treatment, because hepatitis C progresses very slowly. New medicines are helping to cure hepatitis C in more people. Talking with your
doctor can help you decide whether medicines are right for you.
hepatitis C damages your liver so severely that it no
longer works well (end-stage liver failure), you may need a liver transplant to
extend your life. Liver transplants aren't common.
liver transplant is the only surgical treatment that
can help people with end-stage liver failure.
Liver transplantation is a
risky, expensive procedure. And donor organs are hard to get. Most of the
time, only people who are in good health (other than having liver disease) are
considered for a transplant. You will not be considered if you are drinking
alcohol, using illegal drugs, or have certain mental health problems.
liver transplant, you will need lifelong follow-up care by a specialist. You
also will need to take immunosuppressant medicine to keep your body from
rejecting the new liver. This medicine may cause other problems.
Hepatitis C almost always infects the newly transplanted liver. Recurring
liver disease after a transplant can be a serious problem and may cause the new
organ to fail. But most patients do very well after a liver transplant and are
able to live normal lives.
Some people seek out
complementary medicines or alternative ways to treat
hepatitis C. At this time, no complementary or
alternative medicines have been proved to reduce symptoms or cure hepatitis C.
In fact, some herbal therapies (such as
kava) may actually damage the liver.15
Rigorous studies of the herb
milk thistle show that it does not protect the liver from
damage.16, 17 Talk to your doctor if you are thinking about trying milk thistle
or any other complementary therapy to treat hepatitis C.
This clearinghouse is a service of the U.S. National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the
U.S. National Institutes of Health. The clearinghouse answers questions;
develops, reviews, and sends out publications; and coordinates information
resources about digestive diseases. Publications produced by the clearinghouse
are reviewed carefully for scientific accuracy, content, and readability.
Terrault NA, et al. (2013). Sexual transmission of hepatitis C virus among monogamous heterosexual couples: The HCV Partners Study. Hepatology, 57(3): 881–889.
Dienstag JL (2010). Chronic viral hepatitis. In GL
Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed., vol. 1, pp.
1593–1670. Philadelphia: Churchill Livingstone Elsevier.
Flamm SL (2003). Chronic hepatitis C virus infection.
JAMA, 289(18): 2413–2417.
Smith BD, et al. (2012). Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945–1965. MMWR, 61(RR-4): 1–32. Available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6104a1.htm.
U.S. Preventive Services Task Force (2013). Screening for Hepatitis C Virus Infection in Adults: Recommendation Statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspshepc.htm.
Wiegand J, et al. (2006). Early monotherapy with
pegylated interferon alfa-2b for acute hepatitis C infection: The HEP-NET Acute
HCV-II Study. Hepatology, 43(2): 250–256.
Centers for Disease Control and Prevention
(2012). Hepatitis C FAQs for health professionals. Available online:
Ward RP, et al. (2004). Management of hepatitis C:
Evaluating suitability for drug therapy. American Family Physician, 69(6): 1429–1438.
Singal AK, et al. (2010). Antiviral therapy reduces risk of hepatocellular carcinoma in patients with hepatitis C virus-related cirrhosis, Clinical Gastroenterology and Hepatology, 8(2): 192–199.
Morgan RL, et al. (2013). Eradication of hepatitis C virus infection and the development of
hepatocellular carcinoma: A meta-analysis of observational studies. Annals of Internal Medicine, 158(5, Part 1): 329–337.
Ghany MG, et al. (2011). An update on
treatment of genotype 1 chronic hepatitis C virus infection: 2011 practice guideline by the
American Association for the Study of Liver Diseases. Hepatology, 54(4): 1433–1444. Also available online: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3229841.
Ghany MG, et al. (2009). Diagnosis, management, and treatment of hepatitis C: An update. Hepatology, 49(4): 1335–1374. Also available online: http://onlinelibrary.wiley.com/doi/10.1002/hep.22759/full.
Pawlotsky JM, McHutchinson J (2012). Chronic
viral and autoimmune hepatitis. In L Goldman, A Shafer, eds.,
Goldman's Cecil Medicine, 24th ed., pp.
973–979. Philadelphia: Saunders.
Bacon BR, et al. (2011). Boceprevir for previously treated chronic HCV genotype 1 infection. New England Journal of Medicine, 364(13): 1207–1217.
U.S. Food and Drug Administration (2009). Consumer advisory: Kava-containing dietary supplements may be associated with severe liver injury. Available online: http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm085482.htm.
National Center for Complementary and Alternative
Medicine (2012). Get the Facts: Hepatitis C: A Focus on Herbal Supplements (NCCAM Publication No. D422). Washington,
DC: U.S. National Institutes of Health. Available online:
Fried MW, et al. (2012). Effect of silymarin (milk thistle) on liver disease in patients with chronic hepatitis C unsuccessfully treated with interferon therapy: A randomized controlled trial. JAMA, 308(3): 274–282.
Other Works Consulted
Centers for Disease Control and Prevention
(2005). Guidelines for Viral Hepatitis Surveillance and Case Management. Available online:
Craxi A, Licata A (2006). Acute hepatitis C: In search
of the optimal approach to cure. Hepatology, 43(2):
Everson GT, et al. (2008). Quantitative
tests of liver function measure hepatic improvement after sustained virological
response: Results from the HALT-C trial. Alimentary Pharmacology and Therapeutics, 29(5): 589–601.
Mack CL, et al. (2012). NASPGHAN practice guidelines: Diagnosis and management of hepatitis C infection in infants, children, and adolescents. Journal of Pediatric Gastroenterology and Nutrition, 54(6): 838–855.
Maylin S, et al. (2008). Eradication of
hepatitis C virus in patients successfully treated for chronic hepatitis C.
Mohsen A, Norris S (2010). Hepatitis C (chronic), search date April 2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
August 15, 2013
E. Gregory Thompson, MD - Internal Medicine & W. Thomas London, MD - Hepatology
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