Table of ContentsView AllTable of ContentsTransmissionSymptomsComplicationsRisk FactorsDiagnosisTreatmentPreventionLiving Well
Table of ContentsView All
View All
Table of Contents
Transmission
Symptoms
Complications
Risk Factors
Diagnosis
Treatment
Prevention
Living Well
For some, however, the infection can progress and becomechronic, leading to liver injury,cirrhosis(liver scarring), and evenliver cancer.Fortunately, a newer class of drugs calleddirect-acting antivirals (DAA)can treat all stages of HCV infection, offering cure rates as high as 99%.
This article looks at the causes and symptoms of HCV infection, including how hepatitis C is diagnosed, treated, and prevented.
Henry Steadman / Getty Images
How Do You Get Hepatitis C?
Among the possible routes of HCV infection in the United States are:
Unlikely modes of transmission include tattoos, body piercings, dental procedures, and blood transfusions (due to the routine screening of the U.S. blood supply).
How Hepatitis C Is Not Spread
Is Hepatitis Contagious?
Hepatitis C Symptoms
Acute Symptoms
The majority of people initially infected with HCV areasymptomatic(meaning without symptoms). Only between 20% and 30% develop symptoms, usually within two to 12 weeks of exposure to the virus.
Common symptoms of acute hepatitis C include:
Chronic Symptoms
Around 45% of people acutely infected with HCV will spontaneously clear the virus within a year of exposure and may never even realize they’ve had the infection. The remainder will develop a chronic infection in which HCV causes persistent inflammatory damage to the liver over the course of 20 or more years.
While most people have minimal or no symptoms during the early decades of a chronic HCV infection, as many as one in three will experience vague symptoms such as:
These can occur even before there is any significant damage to the liver.
Cirrhosis
As hepatitis C progresses, around 20% to 25% will developcirrhosis, in which progressive scarring of the liver makes it function less and less effectively. Most cases develop within 30 years of the acute infection, causing ever-worsening symptoms as the liver damage mounts.
Early signs of cirrhosis include:
After 10 years, between 10% and 40% of people with HCV-associated cirrhosis will experience decompensation. This is when damage to the liver is so extensive that it is no longer functional.
Signs of decompensated cirrhosis include:
Without treatment, decompensated cirrhosis will lead toliver failureand death.
Symptoms in Females and Males
The symptoms of hepatitis C are the same whether you arefemaleormale. Where they differ is in the rate of infection and the speed at which the disease can progress in those who are chronically infected.
Researchers at the University of Southern California Medical Center highlighted the differences in a 2014 review published in theJournal of Infectious Diseases:
Complications of Hepatitis C
In addition to cirrhosis, a person with chronic hepatitis C can experience other complications involving the liver and other organ systems, including:
What Causes Hepatitis C?
There are seven genetic types of HCV—referred to as HCV genotypes 1 through 7—which vary in their incidence (rate of infection), virulence (aggressiveness), and response to HCV treatment.
HCV Genotypes in the United StatesHCV genotype 1 accounts for 60% of global hepatitis C infections and is the predominant type in the United States. HCV genotypes 2 and 3 are less common forms seen in North America.
HCV Genotypes in the United States
HCV genotype 1 accounts for 60% of global hepatitis C infections and is the predominant type in the United States. HCV genotypes 2 and 3 are less common forms seen in North America.
As a bloodborne infection, injecting drug use is the most common risk factor for contracting HCV. However, there are people who get hepatitis C without any known exposure to blood or a history of drug use.
In the United States, the people most at risk of hepatitis C include:
Hepatitis C Testing
Hepatitis C is diagnosedthrough a combination of blood tests. These tests can tell if you have HCV, which type you have, and whether yours was a recent or long-standing infection.
HCV Antibody Tests
These tests return either a reactive/positive result (meaning that HCV antibodies were detected) or a nonreactive/negative result (meaning that HCV antibodies were not detected). Once you have HCV antibodies, you will always have HCV antibodies.
Because it takes time for your body to produce antibodies, you can get afalse-negative result(meaning the test wrongly shows you do not have the condition) if you test earlier than eight weeks after the suspected exposure. The averagewindow periodfor HCV—when antibodies are below the level for detection—is between eight and 11 weeks.
HCV RNA Test
HCVRNA testsdetect the genetic material of HCV. The qualitative HCV RNA test can confirm that you have the virus, while the quantitative HCV RNA test counts the actual number of viruses in your blood (called the HCV viral load).
Unlike HCV antibody tests, HCV RNA tests can identify HCV relatively quickly—usually in one to two weeks. This can be useful in detecting acute infections. If the RNA test is positive but the antibody test is negative, it means that the infection was recent.
This is important because almost half of all acute infections clear within a year.In such cases, a healthcare provider may wait to see if clearance occurs before subjecting a person to treatment.
HCV Genotyping
Determining the HCV genotype is essential because it helps direct which drugs are most effective for the type you have.Several tests are licensed for HCV genotyping. These can tell which genotype you have and can also tell if you have asuperinfection(meaning that you have more than one genotype).
Hepatitis C Treatment
Direct-acting antivirals (DAAs) are a newer class of drugs that can achieve cure rates of over 90%, even among people with decompensated cirrhosis. For those without decompensated cirrhosis, cure rates are closer to 99%.
There are five DAAs licensed for use in the United States that are comprised of two or more individual agents:
Upon completion of treatment, your response will be evaluated with a succession of HCV viral load tests. A “cure” is defined as having an undetectable viral load for 24 weeks, also known as sustained virological response 24 (SVR24).
Affordability of Hepatitis C DrugsHepatitis C treatment is expensive, ranging from $25,000 to $95,000 depending on the drug and duration of treatment.You can significantly reduce the cost of treatment with:Manufacturer’s prescription assistanceNonprofit drug assistance programs likeHealthWell Foundation,PAN Foundation, andPatient Advocate FoundationPharmacy co-pay assistance likeOptum Specialist Pharmacy,Curant Health, andRx Connect
Affordability of Hepatitis C Drugs
Hepatitis C treatment is expensive, ranging from $25,000 to $95,000 depending on the drug and duration of treatment.You can significantly reduce the cost of treatment with:Manufacturer’s prescription assistanceNonprofit drug assistance programs likeHealthWell Foundation,PAN Foundation, andPatient Advocate FoundationPharmacy co-pay assistance likeOptum Specialist Pharmacy,Curant Health, andRx Connect
Hepatitis C treatment is expensive, ranging from $25,000 to $95,000 depending on the drug and duration of treatment.
You can significantly reduce the cost of treatment with:
How to Prevent Hepatitis C
Here are nine ways to do so:
CDC Testing RecommendationsThe CDC recommends hepatitis C screening at least once in a lifetime for all adults 18 and over. Screening is also advised for all pregnant people during each pregnancy,
CDC Testing Recommendations
The CDC recommends hepatitis C screening at least once in a lifetime for all adults 18 and over. Screening is also advised for all pregnant people during each pregnancy,
Living With Chronic Hepatitis C
Though access to hepatitis C drugs has improved in recent years, it may still take time before you can access treatment. In the meantime, there are steps you can take to stay healthy and prevent any further injury to your liver, including:
Coping and Living Well With Hepatitis C
19 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.Hepatitis C questions and answers for the public.AASLD-IDSA HCV Guidance Panel.Hepatitis C guidance 2018 update: AASLD-IDSA recommendations for testing, managing, and treating hepatitis C virus infection.Clin Infect Dis.2018:67(10):1477-92. doi:10.1093/cid/ciy585Centers for Disease Control and Prevention.Hepatitis C questions and answers for health professionals.Hepatitis C Trust.Needlestick injury.Terrault NA, Dodge JL, Murphy EL , et al.Sexual transmission of hepatitis C virus among monogamous heterosexual couples: the HCV Partners Study.Hepatology.2013;57(3):881–889. doi:10.1002/hep.26164Seo S, Silverberg MJ, Hurley LB, et al.Prevalence of spontaneous clearance of hepatitis C virus infection doubled from 1998 to 2017.Clin Gastroenterol Hepatol.2020 Feb;18(2):511–3. doi:10.1016/j.cgh.2019.04.035Barreira DP, Marinho RT, Bicho M, Fialho R, Ouakinin SRS.Psychosocial and neurocognitive factors associated with hepatitis C - implications for future health and wellbeing.Front Psychol. 2019;9:2666. doi:10.3389/fpsyg.2018.02666Lingala S, Ghany MG.Natural history of hepatitis C.Gastroenterol Clin North Am.2015;44(4):717–734. doi:10.1016/j.gtc.2015.07.003National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms and causes of cirrhosis.Baden R, Rockstroh JK, Buti M.Natural history and management of hepatitis C: Does sex play a role?.J Infect Dis.2014;209 Suppl 3:S81-5. doi:10.1093/infdis/jiu057Cacoub P.Extrahepatic manifestations of chronic hepatitis C virus infection.Ther Adv Infect Dis.2016;3(1):3–14. doi:10.1177/2049936115585942Keikha M, Eslami M, Yousefi B, et al.HCV genotypes and their determinative role in hepatitis C treatment.Virusdisease.2020;31(3):235–240. doi:10.1007/s13337-020-00592-0Hepatitis C Foundation.Genotypes of hepatitis C.New York State Department of Health.Who’s at risk for hepatitis C.Verna EC, Morelli G, Terrault NA, et al.DAA therapy and long-term hepatic function in advanced/decompensated cirrhosis: real-world experience from HCV-TARGET cohort.J Hepatol.2020;73(3):540-548. doi:10.1016/j.jhep.2020.03.031Department of Veteran Affairs.Classification of direct-acting antiviral agents in HCV treatment regimens.Boston University School of Public Health.Subscription-based payment models may improve access to hepatitis C medications.Schillie S, Wester C, Osborne M, Wesolowski L, Ryerson AB.CDC recommendations for Hepatitis C screening among adults — United States, 2020.MMWR Recomm Rep2020;69(No. RR-2):1–17. doi:10.15585/mmwr.rr6902a1Vermont Department of Health.Living with hep C.
19 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.Hepatitis C questions and answers for the public.AASLD-IDSA HCV Guidance Panel.Hepatitis C guidance 2018 update: AASLD-IDSA recommendations for testing, managing, and treating hepatitis C virus infection.Clin Infect Dis.2018:67(10):1477-92. doi:10.1093/cid/ciy585Centers for Disease Control and Prevention.Hepatitis C questions and answers for health professionals.Hepatitis C Trust.Needlestick injury.Terrault NA, Dodge JL, Murphy EL , et al.Sexual transmission of hepatitis C virus among monogamous heterosexual couples: the HCV Partners Study.Hepatology.2013;57(3):881–889. doi:10.1002/hep.26164Seo S, Silverberg MJ, Hurley LB, et al.Prevalence of spontaneous clearance of hepatitis C virus infection doubled from 1998 to 2017.Clin Gastroenterol Hepatol.2020 Feb;18(2):511–3. doi:10.1016/j.cgh.2019.04.035Barreira DP, Marinho RT, Bicho M, Fialho R, Ouakinin SRS.Psychosocial and neurocognitive factors associated with hepatitis C - implications for future health and wellbeing.Front Psychol. 2019;9:2666. doi:10.3389/fpsyg.2018.02666Lingala S, Ghany MG.Natural history of hepatitis C.Gastroenterol Clin North Am.2015;44(4):717–734. doi:10.1016/j.gtc.2015.07.003National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms and causes of cirrhosis.Baden R, Rockstroh JK, Buti M.Natural history and management of hepatitis C: Does sex play a role?.J Infect Dis.2014;209 Suppl 3:S81-5. doi:10.1093/infdis/jiu057Cacoub P.Extrahepatic manifestations of chronic hepatitis C virus infection.Ther Adv Infect Dis.2016;3(1):3–14. doi:10.1177/2049936115585942Keikha M, Eslami M, Yousefi B, et al.HCV genotypes and their determinative role in hepatitis C treatment.Virusdisease.2020;31(3):235–240. doi:10.1007/s13337-020-00592-0Hepatitis C Foundation.Genotypes of hepatitis C.New York State Department of Health.Who’s at risk for hepatitis C.Verna EC, Morelli G, Terrault NA, et al.DAA therapy and long-term hepatic function in advanced/decompensated cirrhosis: real-world experience from HCV-TARGET cohort.J Hepatol.2020;73(3):540-548. doi:10.1016/j.jhep.2020.03.031Department of Veteran Affairs.Classification of direct-acting antiviral agents in HCV treatment regimens.Boston University School of Public Health.Subscription-based payment models may improve access to hepatitis C medications.Schillie S, Wester C, Osborne M, Wesolowski L, Ryerson AB.CDC recommendations for Hepatitis C screening among adults — United States, 2020.MMWR Recomm Rep2020;69(No. RR-2):1–17. doi:10.15585/mmwr.rr6902a1Vermont Department of Health.Living with hep C.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Centers for Disease Control and Prevention.Hepatitis C questions and answers for the public.AASLD-IDSA HCV Guidance Panel.Hepatitis C guidance 2018 update: AASLD-IDSA recommendations for testing, managing, and treating hepatitis C virus infection.Clin Infect Dis.2018:67(10):1477-92. doi:10.1093/cid/ciy585Centers for Disease Control and Prevention.Hepatitis C questions and answers for health professionals.Hepatitis C Trust.Needlestick injury.Terrault NA, Dodge JL, Murphy EL , et al.Sexual transmission of hepatitis C virus among monogamous heterosexual couples: the HCV Partners Study.Hepatology.2013;57(3):881–889. doi:10.1002/hep.26164Seo S, Silverberg MJ, Hurley LB, et al.Prevalence of spontaneous clearance of hepatitis C virus infection doubled from 1998 to 2017.Clin Gastroenterol Hepatol.2020 Feb;18(2):511–3. doi:10.1016/j.cgh.2019.04.035Barreira DP, Marinho RT, Bicho M, Fialho R, Ouakinin SRS.Psychosocial and neurocognitive factors associated with hepatitis C - implications for future health and wellbeing.Front Psychol. 2019;9:2666. doi:10.3389/fpsyg.2018.02666Lingala S, Ghany MG.Natural history of hepatitis C.Gastroenterol Clin North Am.2015;44(4):717–734. doi:10.1016/j.gtc.2015.07.003National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms and causes of cirrhosis.Baden R, Rockstroh JK, Buti M.Natural history and management of hepatitis C: Does sex play a role?.J Infect Dis.2014;209 Suppl 3:S81-5. doi:10.1093/infdis/jiu057Cacoub P.Extrahepatic manifestations of chronic hepatitis C virus infection.Ther Adv Infect Dis.2016;3(1):3–14. doi:10.1177/2049936115585942Keikha M, Eslami M, Yousefi B, et al.HCV genotypes and their determinative role in hepatitis C treatment.Virusdisease.2020;31(3):235–240. doi:10.1007/s13337-020-00592-0Hepatitis C Foundation.Genotypes of hepatitis C.New York State Department of Health.Who’s at risk for hepatitis C.Verna EC, Morelli G, Terrault NA, et al.DAA therapy and long-term hepatic function in advanced/decompensated cirrhosis: real-world experience from HCV-TARGET cohort.J Hepatol.2020;73(3):540-548. doi:10.1016/j.jhep.2020.03.031Department of Veteran Affairs.Classification of direct-acting antiviral agents in HCV treatment regimens.Boston University School of Public Health.Subscription-based payment models may improve access to hepatitis C medications.Schillie S, Wester C, Osborne M, Wesolowski L, Ryerson AB.CDC recommendations for Hepatitis C screening among adults — United States, 2020.MMWR Recomm Rep2020;69(No. RR-2):1–17. doi:10.15585/mmwr.rr6902a1Vermont Department of Health.Living with hep C.
Centers for Disease Control and Prevention.Hepatitis C questions and answers for the public.
AASLD-IDSA HCV Guidance Panel.Hepatitis C guidance 2018 update: AASLD-IDSA recommendations for testing, managing, and treating hepatitis C virus infection.Clin Infect Dis.2018:67(10):1477-92. doi:10.1093/cid/ciy585
Centers for Disease Control and Prevention.Hepatitis C questions and answers for health professionals.
Hepatitis C Trust.Needlestick injury.
Terrault NA, Dodge JL, Murphy EL , et al.Sexual transmission of hepatitis C virus among monogamous heterosexual couples: the HCV Partners Study.Hepatology.2013;57(3):881–889. doi:10.1002/hep.26164
Seo S, Silverberg MJ, Hurley LB, et al.Prevalence of spontaneous clearance of hepatitis C virus infection doubled from 1998 to 2017.Clin Gastroenterol Hepatol.2020 Feb;18(2):511–3. doi:10.1016/j.cgh.2019.04.035
Barreira DP, Marinho RT, Bicho M, Fialho R, Ouakinin SRS.Psychosocial and neurocognitive factors associated with hepatitis C - implications for future health and wellbeing.Front Psychol. 2019;9:2666. doi:10.3389/fpsyg.2018.02666
Lingala S, Ghany MG.Natural history of hepatitis C.Gastroenterol Clin North Am.2015;44(4):717–734. doi:10.1016/j.gtc.2015.07.003
National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms and causes of cirrhosis.
Baden R, Rockstroh JK, Buti M.Natural history and management of hepatitis C: Does sex play a role?.J Infect Dis.2014;209 Suppl 3:S81-5. doi:10.1093/infdis/jiu057
Cacoub P.Extrahepatic manifestations of chronic hepatitis C virus infection.Ther Adv Infect Dis.2016;3(1):3–14. doi:10.1177/2049936115585942
Keikha M, Eslami M, Yousefi B, et al.HCV genotypes and their determinative role in hepatitis C treatment.Virusdisease.2020;31(3):235–240. doi:10.1007/s13337-020-00592-0
Hepatitis C Foundation.Genotypes of hepatitis C.
New York State Department of Health.Who’s at risk for hepatitis C.
Verna EC, Morelli G, Terrault NA, et al.DAA therapy and long-term hepatic function in advanced/decompensated cirrhosis: real-world experience from HCV-TARGET cohort.J Hepatol.2020;73(3):540-548. doi:10.1016/j.jhep.2020.03.031
Department of Veteran Affairs.Classification of direct-acting antiviral agents in HCV treatment regimens.
Boston University School of Public Health.Subscription-based payment models may improve access to hepatitis C medications.
Schillie S, Wester C, Osborne M, Wesolowski L, Ryerson AB.CDC recommendations for Hepatitis C screening among adults — United States, 2020.MMWR Recomm Rep2020;69(No. RR-2):1–17. doi:10.15585/mmwr.rr6902a1
Vermont Department of Health.Living with hep C.
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