Acute vs. Chronic Hepatitis C: How They Differ

Medically Reviewed by Jennifer Robinson, MD on August 11, 2022
Written by Paul Frysh
4 min read

Hepatitis means you have an inflamed liver. The most common cause of the condition is a virus called hepatitis C, or “hep C” for short. (There are other causes like bacteria, injury, and other viruses.)

If you have the hepatitis C virus in your blood for anywhere from a few weeks to a few months, you have “acute” hep C. After 6 months, it’s called “chronic.” Without diagnosis and treatment, chronic hep C can remain for many years and lead to serious symptoms like liver damage.

The virus spreads most often among people who use injected drugs through needles, and through sexual contact. Razors, toothbrushes, and tattoo needles also could carry and transmit the virus of an infected person.

Often, there aren’t any obvious symptoms of hepatitis C, whether it’s acute or chronic. When you do notice symptoms, they could include:

Because a lack of symptoms is so common in the beginning, the first sign of chronic hepatitis C might be from scarring of the liver, called cirrhosis, that sometimes happens in advanced stages of hepatitis. Cirrhosis also might cause:

  • Swelling from fluid in your belly
  • Foggy thinking and memory problems
  • Pain in the upper left of your belly due to an enlarged spleen
  • Tendency to bleed more easily
  • Spider-like blood vessels on your skin called spider angiomas
  • Redness in the palms of your hands

Note that other hepatitis virus types -- A, B, D, and E -- can also cause an inflamed liver and might lead to different symptoms.

Without any obvious signs, a blood test is the best way to tell if you have hepatitis C. The test is the same whether your case is acute or chronic.

To figure out the extent of the illness, health care workers may take special images of your liver with an ultrasound, MRI, or CT scan. In rare cases, your doctor might want to take a small piece of your liver to look at under a microscope. Your doctor might call this a biopsy.

It’s a good idea to get a test for hep C at least once in your life if you’re 18 or older. You should also get a test for the virus if:

Doctors don’t typically treat acute hepatitis C until it's chronic. That’s because in about a quarter of cases, the infection simply goes away.

Some studies show that antiviral treatments might lessen the chance that an acute case will develop into a chronic one. But that’s not certain. The evidence is limited, and many of the treatments are very expensive.

For chronic hepatitis C, doctors most often use medications called direct acting antivirals, or DAAs. These drugs stop the virus from making copies of itself. DAAs are effective for hepatitis C in more than 90% of cases.

Your doctor will likely prescribe some combination of these drugs such as glecaprevir, pibrentasvir, sofosbuvir, velpatasvir for 8-12 weeks. Some pills combine two of these drugs.

But these medications may not be right for everyone because of cost, health issues, and other reasons. For example, DAAs may be problematic if you have:

If blood tests still don’t find the hep C virus 12 weeks or more after you finish treatment, you will likely (in 99% of cases) stay free of the virus for the rest of your life. Though it is possible for the virus to return, this happens less than 1% of the time.

After successful treatment, you can’t pass the virus on to other people. Some doctors might test for hep C one more time, 6 to 12 months after treatment, but most likely, you’re cured of hepatitis.

It is possible to reinfect yourself with hep C, and it can be harder to treat the second time.

After treatment, your doctor may keep a close watch on your liver, especially in cases that are more serious or if you have other health issues.