Reviewed By: Dr. Kurt Kloss, MD
Last Reviewed Date: Sep 25, 2018
Last Modified Date: Sep 25, 2018
Published Date: Aug 08, 2018
Hepatitis C is a viral infection that can cause serious liver damage. Just as there are many types of hepatitis, there are also several forms of hepatitis C. In the United States, approximately 3.9 million people have hepatitis C. Type 1 is the most common in this country. Although it is curable, many people go untreated because they aren't aware that they have the condition.
Symptoms of hepatitis C are subtle and may take decades to appear. It's important that you recognize the symptoms of hepatitis C as soon as they show up to minimize the liver damage associated with the disease.
Transmission of Hepatitis C
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There are five different types of hepatitis, of which hepatitis C is only one. Hepatitis transmission is different for each type. While drinking contaminated water can give you hepatitis A or E, you cannot get hepatitis C in this way. Hepatitis C is usually transmitted by blood — when an individual is exposed to the blood of someone who carries the disease. You can also get hepatitis C through sexual intercourse, though the risk of this is much lower.
Hepatitis C is most commonly contracted through infected needles and other types of medical equipment. Those who inject drugs with non-sterile needles are at a high risk for contracting hepatitis C.
Individuals who received a blood transfusion or organ transplant prior to 1992 may also be at risk for hepatitis C via infected blood that could have been supplied at the hospital. Prior to this year, screening methods did not regularly include testing for hepatitis C. Today, hospitals include hepatitis C screenings routinely, so this is no longer a concern.
In rare cases, an individual may get hepatitis C through contact with a razor, toothbrush, or other personal care item that's contaminated with the blood of an infected person. Those who know they have hepatitis C should not share these items.
It is possible to pass hepatitis C from a mother to baby. An expectant mother who knows that she has hepatitis C should speak with her health care provider about the condition.
You cannot get hepatitis C through casual interaction with an individual. The disease is not passed through saliva, so you cannot catch it from kissing, hugging, sneezing, or coughing. If you know that an individual has hepatitis C, the most important precautions involve practicing safe sex and avoiding any contact with that person's blood. Unfortunately, many people do not know that they have hepatitis C until it's in its later stages and, therefore, may spread it long before they're aware of the condition.
Hepatitis C in the Early Stages
The best time to diagnose hepatitis C is when it's still in the earliest stage, known as the acute stage. If the condition is left to worsen, it becomes more difficult to treat. The symptoms of hepatitis C are easily confused with other conditions. For those with known exposure, it's particularly important to watch for these symptoms.
Symptoms of acute hepatitis C can appear anywhere between four and 15 weeks after the initial exposure. These symptoms typically last between two and 12 weeks. Identifying these symptoms early can help you diagnose hepatitis C long before it becomes a chronic disease. Unfortunately, most people do not experience a serious acute period. Some have only mild symptoms and others may have no symptoms at all.
Acute hepatitis C is often mistaken for a common virus. It looks and feels very much like a cold or flu. Once the symptoms have passed, people assume that the virus is gone. However, if hepatitis C is the underlying cause of the symptoms, the disease will continue to worsen until you're left in a much more serious condition, years in the future.
If you know or suspect that you've been exposed to hepatitis C, you should be particularly mindful of symptoms that might indicate the acute stage of this disease. These symptoms include:
- Abdominal pain, particularly on the upper right
- Joint pain
- Muscle pain
- Loss of appetite
Less commonly, individuals may experience dark urine or clay-colored bowel movements. Jaundice is another symptom that can occur with acute hepatitis C, though it's not seen as often at this early stage. Jaundiced individuals will have a yellowish tinge to their eyes or skin.
It's extremely difficult to distinguish hepatitis C from a common viral infection. If you know that you've been exposed to the blood of another individual or to a needle that could potentially be infected, you should speak with your doctor about whether you could have the condition. Keep in mind that infected individuals often don't know about the problem, so you could get hepatitis C even from someone who believes that they do not have the disease.
Treating Acute Hepatitis C
If you discover that you have acute hepatitis C, your doctor will typically monitor your condition closely to assess how the disease is progressing. In the acute stage, hepatitis C is treated much the same way as the common viral infections that it mimics. Rest, fluids, and a healthy diet are the best treatments. This may help with the patient's recovery, but it does not impact the likelihood that the disease will progress.
Regardless of how the acute stage is handled, between 75 and 85 percent of those with hepatitis C will develop a chronic condition. Other patients experience a spontaneous clearance of the infection and require no further observation or treatment. Spontaneous clearance of acute hepatitis C usually happens within six months of infection.
Individuals may have a period of undetectable hepatitis C between the acute and chronic stages. For this reason, one negative test isn't sufficient to determine whether an individual had a spontaneous clearance. If you have two negative tests spaced several weeks apart, however, you can consider this a successful spontaneous clearance of the disease.
Most patients will go on to have chronic hepatitis C. When the disease reaches this point, your health care provider can discuss treatment options with you. The earlier you diagnose chronic hepatitis C, the better your outcome will be.
Chronic Hepatitis C Symptoms
After the acute stage of hepatitis C has passed, an infected individual may go years before they notice any further signs of the disease. Chronic depression and fatigue can be a sign of hepatitis C, but it's difficult for many people to make the connection since these symptoms can have so many other causes.
Hepatitis C typically affects the liver. Signs of chronic hepatitis C are usually associated with liver failure. Dark urine, jaundiced eyes and skin, and clay-colored bowel movements are all common signs of liver problems.
If you've had hepatitis C for 20 or 30 years, the disease may have caused a condition known as cirrhosis. Cirrhosis is a term used for liver scarring. Symptoms of cirrhosis include water retention, easy bruising or bleeding, and jaundice. About 10 to 20 percent of people with hepatitis C will eventually develop cirrhosis. You're more likely to have cirrhosis if:
- You are 50 years of age or older
- You are male
- You use alcohol
- You have hepatitis B
- You have HIV
- You have non-alcoholic fatty liver disease
- You take immunosuppressant drugs
Cirrhosis may worsen and lead to liver cancer. Of people who have both hepatitis C and cirrhosis, roughly 3 to 6 percent will develop liver failure, and 1 to 5 percent will get liver cancer.
Though it's less common, hepatitis C may also cause symptoms in other parts of the body. It's possible for the hepatitis C infection to cause the formation of cryoglobulins. These abnormal antibodies inflame the arteries and lead to symptoms such as:
- Joint pain
- A raised purplish rash on the legs
- Discolored fingers or toes with pain in cold temperatures
- Pain or swelling in various parts of the body
Anyone experiencing symptoms such as these should speak with a health care provider immediately. Liver failure is always a serious condition, regardless of whether it's the result of a hepatitis C infection or not. If you believe you're experiencing symptoms of chronic hepatitis C, speak with your doctor about the best way to proceed.
Treating Chronic Hepatitis C
If you're diagnosed with hepatitis C before you've developed cirrhosis, your chances of a full recovery are greater. Though it is possible to cure hepatitis C after cirrhosis has occurred, you will still have to deal with the impact of the cirrhosis, which is discussed further in the next section.
Prior to 2011, hepatitis C was treated with interferon and ribavirin. These medications boost the immune system and can help the body overcome the hepatitis C virus. Unfortunately, both drugs have severe side effects.
Since 2011, the United States Food and Drug Administration has approved several other antiviral medications for the treatment of hepatitis C. These have fewer side effects and higher success rates. Some treatments are effective in as little as eight weeks. Options include:
- Daclatasvir-sofosbuvir (Sovodak, Darvoni)
- Elbasvir-grazoprevir (Zepatier)
- Glecaprevir-pibrentasvir (Mavyret)
- Ledipasvir-sofosbuvir (Harvoni)
- Ombitasvir-paritaprevir-ritonavir (Technivie)
- Ombitasvir-paritaprevir-ritonavir and dasabuvir (Viekira Pak)
Thanks to medications like these, it's now possible to cure chronic hepatitis C relatively easily. These protease inhibitors restrict proteins to the virus so it cannot reproduce, effectively causing it to die out. Most treatments will cure the disease in less than 24 weeks. The viral cure rate for hepatitis C is now over 90 percent.
Your doctor will consider you cured if you achieve a sustained virologic response (SVR). This means that the hepatitis C virus is too low for detection three months after your treatment cycle is complete.
If you have or have had hepatitis C, you should take extra measures to protect your liver. These include avoiding alcohol and speaking with a health care provider before taking supplements, herbs, or any prescription or over-the-counter medications.
Hepatitis C and Cirrhosis
The hepatitis C virus typically settles in the body's liver cells to reproduce. The virus uses the cell's RNA material to replicate itself, releasing these copies to settle in other liver cells and continue the process. This process causes continuous damage to the liver as long as the virus keeps reproducing. This damage is exacerbated by the body's own immunological response. As the body fights the virus, it can do additional damage to the liver, which essentially serves as the battlefield for this disease.
Though the liver may only experience inflammation in the early stages of the disease, over time it will undergo permanent damage and scarring known as cirrhosis. Even if the hepatitis C virus is eliminated, the cirrhosis will remain. Cirrhosis has two phases. In the compensated phase, the patient is often asymptomatic and the liver is still functioning well. In the decompensated phase, liver function is compromised. Cirrhosis can block blood flow in the liver, making it nearly impossible for this organ to do its job.
Between 5 and 20 percent of people with hepatitis C develop cirrhosis. It usually takes between 20 and 30 years for cirrhosis to develop. If cirrhosis is left untreated, it may lead to liver failure. Cirrhosis is also the leading cause of liver cancer. Over 70 percent of individuals with liver cancer developed this as a result of cirrhosis of the liver. Ultimately, cirrhosis and liver cancer are responsible for 1 to 5 percent of deaths that are related to hepatitis C.
Early symptoms of cirrhosis include a loss of appetite, weight loss, fatigue, and weakness. As the condition progresses, symptoms will include:
- Jaundiced skin and eyes
- Muscle cramps
- Spider veins
- Itching skin
- Swelling of the feet and legs
- A feeling of fullness in the belly
- Difficulty taking deep breaths
If cirrhosis continues to worsen, the patient may develop end-stage liver disease. Symptoms include all of the above as well as easy bruising and bleeding plus difficulty with memory and concentration. The only treatment for end-stage liver disease is a liver transplant. In the United States, hepatitis C is the leading cause of liver transplants.
Risk Factors for Hepatitis C
Since the symptoms for hepatitis C are so subtle in the earlier stages, it's particularly important for people to understand their risk factors. If you have a high risk factor for hepatitis C, it's worthwhile to discuss this with your physician and explore the best course of action in regards to hepatitis C testing.
If you were born between 1945 and 1965, you're five times more likely to have hepatitis C than other adults. Roughly 75 percent of people with hepatitis C were born in this period. Transmission of hepatitis C was at its highest between the 1960s and 1980s, which is when most of these baby boomers likely contracted the disease.
Poor infection control procedures may have transmitted the virus to patients via medical equipment. Contaminated blood and blood products were another source of infection during this period, as screening processes for hepatitis C were not yet established. Shared needles or contact with another individual's infected blood may also transmit hepatitis C. Infected individuals rarely know exactly how they got the disease.
Injection drug use is one of the most common risk factors for those who are infected with hepatitis C today. Those who snort cocaine with shared equipment have a higher risk factor as well. A massive 80 percent of new drug users get hepatitis C within 12 months.
Others who have a higher risk factor for hepatitis C include health care workers who have suffered needle-stick accidents and people who have high-risk sexual behavior. Infants of mothers who have hepatitis C have a higher risk of carrying the disease as well.
Since hepatitis C is transmitted through infected blood, you should make sure proper sterilization procedures are always used when you're getting tattoos, piercings, acupuncture, and even manicures and pedicures. If you have medical or dental work done in a developing country, sterilization might be a concern as well.
If you live with someone who has a known hepatitis C infection, your risk of contracting the disease is naturally higher. You should never share toothbrushes or other personal hygiene items with someone who is known to carry hepatitis C. Use safe sex practices if you're intimate with this individual. Remember that many cases of hepatitis C are curable. If someone you know has the disease, encourage him or her to speak with a doctor about treatment options.
Testing for Hepatitis C
There are three parts to hepatitis C testing. The first step is testing for the antibodies. Individuals will have antibodies to hepatitis C in their blood two to three months after the initial infection. If you test positive for the antibodies, you have or have had hepatitis C. It's still possible at this point that you may not have the disease currently, as some people will clear the virus on their own.
A viral load test is the second step in testing for hepatitis C. A viral load test will determine whether someone with antibodies cleared the virus from the system or continues to have it. A viral load test can also detect hepatitis C in people who have contracted the disease too recently to have antibodies. Therefore, a viral load test is important for all individuals, whether the hepatitis C antibodies are present or not.
Your health care provider can order both quantitative and qualitative HCV viral load testing. Qualitative testing is the more sensitive of the two. This simply determines whether the virus is present or not. Quantitative testing determines how much HCV is in the patient's blood. Your doctor may order repeated HCV viral load tests during the treatment process if you have hepatitis C, as this will indicate how well the treatment program is working.
The final test performed for patients with hepatitis C is HCV genotype testing. This determines which of the eight possible genotypes you have. The specific type of hepatitis C that you're carrying will determine which treatment method is most appropriate for your disease. The most common HCV genotype is 1, which accounts for over 46 percent of cases worldwide and 75 percent of cases in the United States. Genotypes 2, 3, and 4 are less common, while the remaining genotypes are rare or unheard of in the United States.
The Progress of Hepatitis C Treatment
Until recently, only two drugs were approved for the treatment of hepatitis C. Fortunately, there are now several treatment options that have effectively demonstrated higher effectiveness, shorter treatment durations, and fewer side effects. The modern outlook is increasingly favorable for patients in all stages of hepatitis C, including those with cirrhosis.
Though most treatments are not for people with decompensated cirrhosis, there are some options available now for these patients. Epclusa is a once-daily tablet that is approved for treatment of HCV genotypes 1 through 6. In combination with Ribavirin, it may be used for those with advanced cirrhosis. The cure rate was an impressive 94 percent after 12 weeks of treatment with Epclusa and Ribavirin for those with HCV 1-6 and decompensated cirrhosis.
The biggest challenge with modern hepatitis C treatments is typically the cost. A 12-week treatment can cost up to $95,000. As treatment options become more widespread and more competitive, prices may drop. Zepatier from Merck boasts a cure rate up to 97 percent with genotype 1 and costs $54,600 for a 12-week treatment, which is an improvement over other options.
Patients with hepatitis C may be particularly interested in following proposed legislation, which might cap drug costs and make these medications more affordable and accessible to them. The high success rates of the drugs do justify the cost to some, but patients are still faced with the logistics of affording this costly cure.
Hepatitis C is an incredibly widespread disease, so it's crucial for anyone who is at a higher risk factor or experiencing possible symptoms to know about this danger. Fortunately, blood testing can let you know if you have hepatitis C so you can work with your doctor to determine the next steps. When you identify hepatitis C early, you can often cure the disease before you're facing serious liver damage and potentially life-threatening consequences. Talk to your doctor and find out whether hepatitis C testing is a good idea for you.