What is Hepatitis C?

Hepatitis C is a liver disease caused by infection with the hepatitis C virus. The virus causes liver inflammation, which interferes with proper liver function. Hepatitis C can eventually lead to severe, permanent liver damage and cirrhosis and may be complicated by liver cancer. Because the initial symptoms are mild, hepatitis C often goes unnoticed until years later when liver damage is discovered.

There are six major strains, or genotypes, of hepatitis C. Genotype 1 is the most common type in the United States. Types 1, 2 and 3 are found worldwide; type 4 is found throughout Africa, 5 is common in South Africa, and 6 is common in Asia.

What causes hepatitis C infection?

Hepatitis C is caused by the hepatitis C virus (HCV). This virus enters the body through infected blood (much less commonly through other body fluids) and then multiplies in liver cells.

What are the symptoms?

Most infections begin with a sudden (acute) illness, often so mild that you may not notice symptoms. Many people with acute illness will go on to develop long-term (chronic) infection. ¹ Hepatitis C is considered chronic when the liver is inflamed for longer than 6 months.

In cases of acute infection, young children usually have no symptoms. Older children and adults may develop mild symptoms, such as fatigue, headache, sore muscles, abdominal pain (specifically, pain in the upper right quadrant), and dark urine. In some cases, jaundice—a condition in which the skin and whites of the eyes appear yellow—may also develop, but this is uncommon in acute hepatitis C infections.

In cases of chronic infection, most people, especially young children, have no symptoms. If symptoms develop, they may include fatigue, mild abdominal discomfort, dry skin and itching, and a general sense of not feeling well (malaise).

How is Hepatitis C diagnosed?

Hepatitis C is diagnosed with blood tests that look for signs of liver inflammation, antibodies to the hepatitis C virus, and its genetic material.

A liver biopsy may be performed to see whether the virus has scarred or damaged the liver, help determine the most appropriate treatment, and see whether treatment is successful.

How is it treated?

Chronic HCV infection may be treated with medications that fight viral infections. The current standard treatment combines two antiviral medications: peginterferon and ribavirin. However, this treatment is not an option for everyone because of its significant side effects or because of continuing problems with substance abuse, psychological conditions (such as schizophrenia) that interfere with the ability to take scheduled medications, or financial constraints (the medications are expensive).

A new form of interferon, called peginterferon, combined with ribavirin stops the virus more effectively than standard interferon and ribavirin. ² As a result, the combination of peginterferon and ribavirin has become the new standard of treatment. ³

Your response to treatment depends in part on which of the six hepatitis genotypes you have—and you may be infected with more than one genotype. Genotype 1 does not respond as well to treatment as the less-common genotypes 2 and 3. Other factors, such as the amount of virus in your system (viral load) and whether your liver has been scarred or damaged, may also affect how well you respond to treatment.

How is Hepatitis C spread?

The incubation period (the time it takes for the first symptoms to appear) is about 2 weeks to 6 months.

Anyone who tests positive for the hepatitis C virus (HCV) RNA is presumed to be contagious.

HCV spreads through contact with blood, most commonly by sharing needles and other equipment used to inject drugs. Health care workers face a low risk (less than 2%) of infection from accidental needle sticks and other occupational exposures.

The virus can spread through sexual contact, but the risk is low, especially for long-term monogamous couples. Risk increases for those who have multiple sex partners. Having a sexually transmitted disease or being infected with HIV may increase the risk of becoming infected with HCV.

In the past, the virus was spread through infected blood used in transfusions and infected solid organs used in transplantation. However, the risk of infection from these procedures is now extremely low; since around 1990, blood and organs have been routinely screened for hepatitis C.

While the risk is low, an infected mother can spread the virus to her baby at birth. The risk of transmitting the disease to the baby can be greater if the mother is also infected with HIV.