Chronic Hepatitis C: The Basics

This long-lasting liver infection is caused by the hepatitis C virus. It begins as an acute hepatitis that starts within the first 6 months of exposure to the virus.

For most people who get it -- up to 85% -- the illness moves into a long-lasting stage. This is called a chronic hepatitis C infection.

Who Gets It?

Most people catch the hep C virus when blood from someone who has it gets into their body. This can happen if you share needles to use drugs, or get stuck by one because you work in a hospital or doctor's office. People born to a mother have a 6% risk that they will get it, too.

You can also get it from having sex with someone who has the virus. Your chances go up if you have a sexually transmitted disease, several partners, or take part in sex that's rough enough to cause bleeding.

You can't get hepatitis C by touching, kissing, coughing, sneezing, sharing utensils, or breastfeeding.

The CDC recommends you get tested for hepatitis C if:

  • You received blood from a donor who later found out they had hepatitis C
  • You’ve ever injected drugs
  • You had a blood transfusion or an organ transplant before July 1992
  • You got a blood product used to treat clotting problems before 1987
  • You were born between 1945 and 1965
  • You've had long-term kidney dialysis
  • You have HIV
  • You were born to a mother with hepatitis C

Since July 1992, all blood and organ donations in the U.S. are tested for the hepatitis C virus. The CDC says it is now rare that someone getting blood products or an organ would get hepatitis C.

What Are the Symptoms?

You can have the disease and not have symptoms for years. You may not find out you have it until your doctor does a blood test for some other reason and notices a problem with your liver enzymes. If you have chronic hepatitis C, your may notice:

You may also have symptoms related to cirrhosis. This condition, which affects people who've had hep C for a long time, causes your liver to scar over:

  • Jaundice (yellowing of the skin and eyes)
  • Dark yellow urine
  • Bleeding or bruising easily

You can find out if you have a hep C with blood tests. If they're positive, you'll likely have more done to make sure your liver is healthy. You may also need a liver biopsy and imaging tests.

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How Is it Treated?

Treatment is different for every person. The FDA has approved:

Hepatitis C treatments are changing quickly. Until recently, the most common method was a blend of shots and pills. It most often combined a shot of interferon or peginterferon with the pills ribavirin and one of several other drugs. This caused some unpleasant side effects.

Your treatment will depend on many things including what type of hepatitis C virus you have. In the U.S., the most common type is genotype 1, followed by genotypes 2 and 3. Genotypes 4, 5 and 6 are very rare in the U.S.

Treatment now centers around direct acting antiviral drugs (DAAs). These medicines are highly effective for most people with hepatitis C and are interferon-free and often ribavirin-free. This means they typically have fewer side effects. The treatments are often simpler -- consisting of fewer pills for a shorter amount of time. DAAs are available as either single drugs or combined with other medicines in one pill.

Glecaprevir and pibrentasvir (Mavyret) offers a shorter treatment cycle of 8 weeks for adult patients with all types of HCV who don’t have cirrhosis and who have not been previously treated. The length of treatment is longer for those who are in a different disease stage.

Elbasvir-grazoprevir (Zepatier), ledipasvir-sofosbuvir (Harvoni), and sofosbuvir-velpatasvir (Epclusa) are once daily combination pills. Depending on the type of hepatitis C infection, these can often cure the disease in 8 to 12 weeks. 

Other treatment options include: daclatasvir (Daklinza); ombitasvir-paritaprevir-ritonavir plus dasabuvir (Viekira Pak, Viekira XR); ombitasvir-paritaprevir-ritonavir (Technivie); or some combinations of simeprevir (Olysio); sofosbuvir (Sovaldi); peginterferon or ribavirin.  Ask your doctor what's best for you, based on your medical needs. All of these drugs are quite expensive, so check with your insurance company or ask your doctor about any drug company assistance programs.

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What’s Your Outlook?

The outlook for most people with hepatitis B who are treated  is now very good. With new treatments, the viral cure rate is above 90%.  The hepatitis virus is considered to be “cured” if no virus shows up in a blood test that is done 3 months after your treatment ends. 

After treatment, make sure you stick with the healthy habits your doctor has instructed and follow up with her regularly. People in whom the virus has not been successfully treated may go on to get cirrhosis and liver disease may need a liver transplant.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on September 10, 2017

Sources

SOURCES:

FDA. News releases. "FDA approves Mavyret for Hepatitis C." 

National Digestive Diseases Information Clearinghouse: "Chronic Hepatitis C: Current Disease Management," "What I need to know about Hepatitis C."

U.S. Department of Veterans Affairs: "Hepatitis C Basics."

CDC: "Hepatitis C Information for the Public."

MedlinePlus, U.S. National Library of Medicine: "U.S. hepatitis C cases down sharply since 1980s."

Paul Gaglio, MD, medical director of liver transplantation, division of hepatology at Montefiore Medical Center.

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

UptoDate: "Patient Information: "Hepatitis C (Beyond the Basics)."

News release, FDA.

 

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