More than 2 million people in the United States live with hepatitis C. Many of them haven't been treated and are at risk for cirrhosis, liver failure, and other complications of the disease, even though new and better medications have made treatment easier and safer than ever before.

Most people don't ignore their hep C. They're unaware of it. Over half of those who have been infected don't know they have the virus.

"The most common reason why someone isn't getting treated is that they're not diagnosed," says Norah Terrault, MD, professor of medicine and chief of the Division of GI and Liver at Keck School of Medicine, University of Southern California.

Hepatitis C is a silent disease that usually doesn't cause symptoms until its late stages, Terrault says. That's why the CDC recommends that everyone ages 18 and older get tested at least once in their lifetime.

Testing is especially important for people who are at higher risk for hep C because they share needles, they have HIV, or they had an organ transplant or blood transfusion in the past. It's also important for pregnant women, who can pass the infection to their unborn baby.

Untreated Hepatitis C Complications

Hepatitis C infects the liver, an organ in your belly that produces bile for digestion and rids your body of toxins. The virus causes inflammation that slowly damages your liver over many years and leaves it scarred.

Without treatment, that damage and scarring can turn into cirrhosis in about 20% of people with the infection.

"Cirrhosis is the end stage of many decades of inflammation and injury," Terrault says. "It means you've got a lot of scarring in your liver, and the scarring is interfering with the function of the liver."

Once you have cirrhosis or liver cancer, "It's difficult to come back from," she adds. "Your treatment becomes a liver transplant or potentially a very complicated cancer therapy."

By treating hepatitis C you'll prevent cirrhosis. And by preventing cirrhosis, you'll avoid liver failure and liver cancer.

Nonliver Complications

Your liver isn't the only organ that hepatitis C can damage. The virus also triggers the production of cryoglobulins, proteins that clump together and cause inflammation. This can increase your risk for kidney disease, blood vessel damage, and skin rashes.

Hepatitis C might also affect your body's ability to use insulin, the hormone that moves sugar from your blood into your cells. About 1 in 3 people with chronic hepatitis C have diabetes. It's such a common problem that doctors routinely monitor their hepatitis C patients' blood sugar levels, Terrault says.

Can the Virus Go Away on Its Own?

That depends on how long you've been infected. About 25% of people who have recently been infected -- called acute hepatitis C -- do clear the virus on their own. People in their 20s and 30s are more likely to clear the virus than those in their 60s and older, Terrault says.

The other 75% of people don't clear the virus within 6 months and develop chronic hepatitis. "For chronic hepatitis C, the answer is no. There is no way to get rid of it," says Ype de Jong, MD, a hepatologist at Weill Cornell Medicine in New York City.

What Treatment Can Do

Once you get tested and find out that you have hep C, treating it not only prevents complications. Medication will most likely cure you.

Treatments have improved dramatically in the last decade. Before 2013, the main option for people with hepatitis C was to take a combination of peginterferon alpha (PEG-Intron) and ribavirin, plus boceprevir or telaprevir. This three-drug cocktail took up to 12 months to work, only cured about half of people who took it, and caused severe side effects.

The introduction of direct-acting antiviral medicines like sofosbuvir (Sovaldi), simeprevir (Olysio), and daclatasvir (Daklinza) was a "game changer," de Jong says. "We could start curing people with interferon-free regimens."

The new generation of hepatitis C drugs work quickly, within 8 to 12 weeks. And they cure about 95% of people who take them.

Plus, they're very safe. "Two-thirds of my patients have zero side effects," de Jong says. "The most common side effects are headaches, fatigue, and some GI discomfort. All are very mild."

If You're on the Fence

Some people who've lived with hepatitis C for many years or who remember the old drugs might worry that going through several weeks of treatment will be tough. "I tell them it's going to be easier than treating your blood pressure in terms of the side effects, and it's going to be shorter," Terrault says. "This is the easiest thing you're going to do in terms of benefitting your health."

Getting treated will lower your risk for cirrhosis, liver cancer, and liver failure. You might also reduce your odds of getting diabetes, and protect your heart and kidneys. "If you treat someone and cure them, you can substantially reduce their future risk of getting those complications," Terrault says.

Plus, you won't be able to pass the virus to anyone else -- including your unborn baby or sexual partner. And once you're cured, you're cured for good. The virus won't come back unless you get reinfected.

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SOURCES:

AJMC: "Hepatitis C: New Treatments Emerge in 2014 That Will Have Profound Implications for Payers."

CDC: "Hepatitis C Questions and Answers for the Public."

Cleveland Clinic: "Cryoglobulinemia."

Frontiers in Endocrinology: "Diabetes and Hepatitis C: A Two-Way Association."

HHS.gov: "Viral hepatitis in the United States: Data and Trends."

Johns Hopkins Medicine: "Liver: Anatomy and Functions."

Medscape: "What are the extrahepatic complications of hepatitis C virus (HCV) infection?"

Norah Terrault, MD, professor of medicine; chief of the Division of GI and Liver, Keck School of Medicine, University of Southern California.

Scientific Reports: "Clearance of hepatitis C virus is associated with early and potent but narrowly-directed, Envelope specific antibodies."

The Hepatitis C Trust: "How hepatitis C damages the liver."

Trends in Microbiology: "Hepatitis C Virus."

U.S. Department of Veterans Affairs: "Hepatitis C medications: An overview for patients."

Ype de Jong, MD, hepatologist, Weill Cornell Medicine, New York City.