Hepatitis C and the Hep C Virus

What Is Hepatitis C?

Hepatitis C is a liver infection caused by the hepatitis C virus. About 3.9 million people in the U.S. have the disease. But it causes few symptoms, so most of them don't know.

There are many forms of the hepatitis C virus, or HCV. The most common in the U.S. is type 1. None is more serious than any other, but they respond differently to treatment.

The illness affects people in different ways and has several stages:

  • Incubation period. This is the time between first exposure to the start of the disease. It can last anywhere from 14 to 80 days, but the average is 45
  • Acute hepatitis C. This is a short-term illness that lasts for the first 6 months after the virus enters your body. After that, some people who have it will get rid of, or clear, the virus on their own.
  • Chronic hepatitis C. If your body doesn’t clear the virus on its own after 6 months, it becomes a long-term infection. This can lead to serious health problems like liver cancer or cirrhosis.
  • Cirrhosis. This disease leads to inflammation that, over time, replaces your healthy liver cells with scar tissue. It usually takes about 20 to 30 years for this to happen, though it can be faster if you drink alcohol or have HIV.
  • Liver cancer. Cirrhosis makes liver cancer more likely. Your doctor will make sure you get regular screenings because there are usually no symptoms in the early stages.

What Are the Symptoms of Hepatitis C?

Many people with hepatitis C have no symptoms. But between 2 weeks and 6 months after the virus enters your bloodstream, you could notice:

  • Clay-colored poop
  • Dark urine
  • Fever
  • Fatigue
  • Jaundice (a condition that causes yellow eyes and skin, as well as dark urine)
  • Joint pain
  • Loss of appetite
  • Nausea
  • Stomach pain
  • Vomiting

Symptoms usually last for 2 to 12 weeks.

What Are the Symptoms of End-Stage Liver Disease?

You could notice acute symptoms along with:

  • Fluid buildup in the abdominal cavity (ascites) or the legs (edema)
  • Gallstones
  • Your brain doesn’t work as well (encephalopathy)
  • Kidney failure
  • Easy bleeding and bruising
  • Intense itching
  • Muscle loss
  • Problems with memory and concentration
  • Spider-like veins on the skin
  • Vomiting blood due to bleeding in the lower esophagus (esophageal varices)
  • Weight loss

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How Does Hep C Spread?

The virus spreads through the blood or body fluids of an infected person.

You can catch it from:

  • Sharing injection drugs and needles
  • Having sex, especially if you have an STD, an HIV infection, several partners, or have rough sex
  • Being stuck by infected needles
  • Birth -- a mother can pass it to a child
  • Sharing personal care items like toothbrushes, razor blades, and nail clippers
  • Getting a tattoo or piercing with unclean equipment

You can’t catch hepatitis C through:

  • Breastfeeding (unless nipples are cracked and bleeding)
  • Casual contact
  • Coughing
  • Hugging
  • Holding hands
  • Kissing
  • Sharing eating utensils
  • Sharing food or drink
  • Sneezing

What Are the Risk Factors for Have Hepatitis C?

The CDC recommends you get tested for the disease if you:

  • Received blood from a donor who had the disease
  • Have ever injected or inhaled drugs
  • Had a blood transfusion or an organ transplant before July 1992
  • Received a blood product used to treat clotting problems before 1987
  • Were born between 1945 and 1965, the age group with the highest rate of infection
  • Have been on long-term kidney dialysis
  • Have HIV
  • Were born to a mother with hepatitis C
  • Have symptoms of liver disease
  • Got a tattoo or piercing with unclean equipment
  • Are or have ever been in prison

Hepatitis C Testing and Diagnosis

Doctors will start by checking your blood for:

Anti-HCV antibodies: These are proteins your body makes when it finds the hep C virus in your blood. They usually show up about 12 weeks after infection.

  • It usually takes a few days to a week to get results, though a rapid test is available in some places.
  • The results can be:
    • Nonreactive, or negative:
      • That may mean you don’t have hep C.
      • If you’ve been exposed in the last 6 months, you’ll need to be retested.
    • Reactive, or positive:
      • That means you have hep C antibodies and you’ve been infected at some point.
      • You’ll need another test to make sure.

If your antibody test is positive, you’ll get this test:

HCV RNA: It measures the number of viral RNA (genetic material from the hepatitis virus) particles in your blood. They usually show up 1-2 weeks after you’re infected.

  • The results can be:
    • Negative: You don’t have hep C.
    • Positive: You currently have hep C.

As part of the diagnosis process, you might also get:

Liver function tests: They measure proteins and enzyme levels, which usually rise 7 to 8 weeks after you’re infected. As your liver gets damaged, enzymes leak into your bloodstream. But you can have normal enzyme levels and still have hepatitis C.

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What Is the Treatment for Hepatitis C?

If you have acute hepatitis C, there is no recommended treatment. If your hepatitis C turns into a chronic hepatitis C infection, there are several medications available:

Interferon and ribavirin used to be the main treatments for hepatitis C. They can have side effects like fatigue, flu-like symptoms, anemia, skin rash, mild anxiety, depression, nausea, and diarrhea.

But hepatitis C treatments have changed a lot in recent years. Now you’re more likely to get one of these medications:

  • Daclastasvir (Daklinza). You’ll take this pill once a day along with sofosbuvir for 12 weeks.
  • Sofosbuvir-velpatasvir (Epclusa). This daily pill, which you take for 12 weeks, should cure your disease.
  • Ledipasvir-sofosbuvir (Harvoni ). This once-daily pill cures the disease in most people in 8-12 weeks.
  • Glecaprevir and pibrentasvir (Mavyret). This daily pill offers a shorter treatment cycle of 8 weeks for adult patients with all types of HCV who don’t have cirrhosis and who haven’t already been treated. The treatment is longer for those who are in a different disease stage. The prescribed dosage for this medicine is 3 tablets daily.
  • Peginterferon (Pegasys). You take this medicine as a shot under your skin once a week. Try to take it the same day at the same time. You might take it alone or with other medications. You’ll take it for 12 to 24 weeks.
  • Ribavirin (Copegus, Moderiba, , Ribasphere, Virazole). This comes as a tablet, capsule, or liquid. You take it with food twice a day, in the morning and evening, for 24 to 48 weeks or longer.
  • Sofosbuvir (Sovaldi) with interferon and ribavirin. Take this tablet at the same time every day with food. You have to take it along with ribavirin and/or interferon, and you’ll probably be on it for 12 to 24 weeks.
  • Ombitasvir-paritaprevir- ( Technivie ): You’ll take this tablet by mouth, possibly along with ribavirin.
  • Ombitasvir-paritaprevir-dasabuvir-ritonavir (Viekira Pack). This treatment is a combo of pills: two that you'll take once a day, and one you'll take twice with meals. You’ll take it for 12 to 24 weeks.
  • Sofosbuvir-velpatasvir-voxilaprevir (Vosevi). This combination is approved to treat adults with chronic HCV, either with no cirrhosis or with compensated cirrhosis (the stage of the disease that doesn't have symptoms), who’ve already had certain treatments.
  • Elbasvir-grazoprevir ( Zepatier ). This once-daily pill has cured the disease in as many as 97% of those treated.

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What Are the Side Effects of Hepatitis C Medications?

The most common effects of hepatitis C drugs depend on the medicine and often include:

  • Flu-like symptoms
  • Fatigue
  • Hair loss
  • Headache
  • Low blood counts
  • Trouble thinking
  • Nervousness
  • Depression

What Are the Complications of Hepatitis C?

About 75% to 85% of people who have it get a long-term infection called chronic hepatitis C. If the condition goes untreated, it can lead to:

Can You Prevent Hepatitis C Infection?

There’s no vaccine to prevent hepatitis C. To help avoid getting the virus:

  • Use a latex condom every time you have sex.
  • Don't share personal items like razors.
  • Do not share needles, syringes, or other equipment when injecting drugs.
  • Be careful if you get a tattoo, body piercing, or manicure. The equipment may have someone else's blood on it.

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on December 02, 2018

Sources

SOURCES:

News release, FDA.

The Cleveland Clinic Department of Gastroenterology.

CDC:  "Hepatitis C FAQs for Health Professionals," “Hepatitis C: Information on Testing and Diagnosis,” “Hepatitis C Questions and Answers for Health Professionals,” “The ABCs of Hepatitis.”

The National Institute of Diabetes and Digestive and Kidney Diseases.

U.S. Department of Veterans Affairs: "Hepatitis C Treatment Side Effects Management Chart," “Viral Hepatitis.”

UpToDate: "Patient Information: "Hepatitis C (Beyond the Basics)," “Clinical manifestations, diagnosis, and treatment of acute hepatitis C virus infection in adults.”

FDA: "FDA approves Mavyret for Hepatitis C." "Mavyret Prescribing Information."

Hepatitis C Online: "Sofosbuvir-Velpatasvir-Voxilaprevir (Vosevi)." "Daclatasvir (Daklinza)."

Canadian Centre for Occupational Health and Safety: “OSH Answers Fact Sheets.”

UC San Diego Health: “The Phases of Hepatitis C

The Hepatitis C Trust: “Chronic phase of hepatitis C,” “The acute phase of hepatitis C.”

Mayo Clinic: “Hepatitis C,” “Hepatitis C: What happens in end-stage liver disease?” “Is acute hepatitis C infection serious?”

Johns Hopkins: “Chronic Liver Disease/Cirrhosis.”

American Liver Foundation: “Diagnosing Hepatitis C.”

CATIE: “How Hep C transmission happens.”

Lab Tests Online: “RNA.”

Medline Plus: “Daclatasvir,” “Ombitasvir, Paritaprevir, and Ritonavir,” “Ribavirin,” “Sofosbuvir,”

HHS AIDSinfo: “Peginterferon Alfa-2a (HBV, HCV).”

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