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    Hepatitis C can wear you out. There’s no getting around it. Of the estimated 3.5 million people in the U.S. who have the virus, at least half say fatigue is one of their symptoms.

    But the link between the virus and feeling so tired isn't always clear.

    Nancy Reau, MD, section chief of hepatology at Rush University Medical Center in Chicago, says that studies have shown that if you can stop the virus from reproducing so much, people feel more energetic.

    "When the hep C is no longer measurable,” she says, "people are less tired.”

    Still, not everyone with hepatitis C feels run down all the time.

    “I think it’s important to recognize that fatigue is a pretty common problem anyway,” says Reau, a member of the American Liver Foundation’s National Medical Advisory Committee. “Sometimes it’s the virus. Sometimes it’s not the virus.”

    There's a more direct link between fatigue and problems like cirrhosis (scarring on the liver) that are more serious. So when faced with someone who has hepatitis C, doctors will try to manage liver disease before dealing with the fatigue.

    If there’s no disease, doctors will look at other possible reasons you're tired that aren't directly related to the virus.

    Those could be psychological. Some of that run-down feeling can come from the emotions and stress that come with a chronic disease. Whatever it is, fatigue can stop those with hep C in their tracks.

    “People sometimes do get a mistaken sense from doctors that, ‘It’s all in your head,’” says Andrew Muir, MD, a hepatologist at Duke Clinical Research Institute in Durham, NC. “But it’s real. The key is, is it related to the liver disease or not?”

    What can you do about that always-tired feeling?

    Talk to Your Doctor

    The first step with any medical issue is to talk to your care team and follow your treatment plan.

    As you’re fighting off that fatigue, remember that hepatitis C is curable. With proper treatment, doctors can rid you of the virus. And, maybe, the fatigue, too.