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Hepatitis C

Definition

Hepatitis C is a viral disease that leads to swelling (inflammation) of the liver.

Other types of viral hepatitis include:

Causes

Hepatitis C infection is caused by the hepatitis C virus (HCV).

You can catch hepatitis C if the blood of someone who has hepatitis C enters your body. Exposure may occur:

People at risk of hepatitis C are those who:

  • Inject street drugs or share a needle with someone who has hepatitis C
  • Have been on long-term kidney dialysis
  • Have regular contact with blood at work (such as a health care worker)
  • Have unprotected sexual contact with a person who has hepatitis C
  • Were born to a mother who had hepatitis C
  • Received a tattoo or acupuncture with needles that were not disinfected properly after being used on another person (risk is very low with practitioners who have a tattoo license or permit or an acupuncture license)
  • Received an organ transplant from a donor who has hepatitis C
  • Share personal items, such as toothbrushes and razors, with someone who has hepatitis C (less common)
  • Received a blood transfusion (rare in the U.S. since blood screening became available in 1992)

Symptoms

Most people who are recently infected with hepatitis C do not have symptoms. Some people have yellowing of the skin (jaundice) that goes away. Chronic infection often causes no symptoms. But tiredness, skin disorders and other problems can occur. Persons who have long-term (chronic) infection often have no symptoms until their liver becomes scarred (cirrhosis). Most people with this condition are ill and have many health problems.

The following symptoms may occur with hepatitis C infection:

  • Pain in the right upper abdomen
  • Abdominal swelling due to fluid (ascites)
  • Clay-colored or pale stools
  • Dark urine
  • Fatigue
  • Fever
  • Itching
  • Jaundice
  • Loss of appetite
  • Nausea and vomiting

Exams and Tests

Blood tests are done to check for hepatitis C:

  • EIA assay to detect hepatitis C antibody
  • Hepatitis C RNA assays to measure virus levels (viral load)

Everyone born from 1945 - 1965 (the “baby boom” generation) should get a one-time test for hepatitis C.

Genetic testing is done to check for the type of hepatitis C (genotype). There are six types of the virus (genotypes 1 through 6). Test results can help your doctor choose treatment that is best for you.

The following tests are done to identify and monitor liver damage from hepatitis C:

  • Albumin level
  • Liver function tests
  • Prothrombin time
  • Liver biopsy

Treatment

Common medicines used include peginterferon and antiviral drugs. These medicines are aimed at:

  • Helping the body get rid of the virus.
  • Reducing the risk of cirrhosis and liver cancer, which can result from long-term HCV infection.

For these medicines to work best, you need to take them as instructed by your health care provider. Ask what side effects you can expect and what to do if you have them.

liver transplant may be recommended for persons who develop cirrhosis and liver cancer. Your health care provider can tell you more about liver transplant.

If you have hepatitis C:

  • Do not take over-the-counter medicines that you have not taken before without asking your health care provider. Also ask about vitamins and other supplements.
  • Do not use alcohol or street drugs. Alcohol can speed up the damage to your liver. It can also reduce how well medicines work.
  • Ask your health care provider whether you need the hepatitis A and hepatitis B vaccines.

Support Groups

Joining a support group can help ease the stress of having hepatitis C. Ask your health care provider about liver disease resources and support groups in your area.

Outlook (Prognosis)

Most people with hepatitis C infection have the chronic form. Persons with genotype 2 or 3 are more likely to respond to treatment than those with genotype 1.

The goal of treatment is to reduce the chance of liver damage and liver cancer. A good response to treatment occurs when the virus is no longer detected in the blood after treatment. New and more effective medicines are being developed. As a result, more and more persons with HCV are able to avoid serious liver damage and liver cancer.

When to Contact a Medical Professional

Call your health care provider if:

  • You develop symptoms of hepatitis
  • You believe you have been exposed to the hepatitis C virus

Prevention

Things that can be done to prevent the spread of hepatitis C from one person to another include:

  • Health care workers should follow precautions when handling blood.
  • Do not share needles with anyone.
  • Do not get tattoos or body piercings or receive acupuncture from someone who does not have a permit or license.
  • Do not share personal items such as razors and toothbrushes.
  • Practice safer sex.

If you or your partner is infected with hepatitis C and you have been in a stable and monogamous (no other partners) relationship, the risk of giving the virus to, or getting the virus from, the other person is low.

Hepatitis C virus cannot be spread by casual contact, such as holding hands, kissing, coughing or sneezing, breastfeeding, sharing eating utensils or drinking glasses.

Currently there is no vaccine for hepatitis C.

References

Chou R, Hartung D, Rahman B, Wasson N, Cottrell EB, Fu R. Comparative effectiveness of antiviral treatment for hepatitis C virus infection in adults: a systematic review. Ann Intern Med. 2013 Jan 15;158(2):114-23.

Ghany MG, Strader DB, Thomas DL, Seeff LB. American Association for the Study of Liver Diseases. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology. 2009;49:1335-1374.

Jou JH, Muir AJ. In the clinic. Hepatitis C. Ann Intern Med. 2008;148:ITC6-1-ITC6-16.

O'Leary JG, Davis GL. Hepatitis C. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Elsevier Saunders; 2010:chap 79.

Rosen HR. Clinical practice. Chronic hepatitis C infection. N Engl J Med. 2011;364(25):2429-38.

Moyer VA; U.S. Preventive Services Task Force. Screening for hepatitis C virus infection in adults: U.S. Preventive services task force recommendation statement. Ann Intern Med. 2013 Sep 3;159(5):349-57.


Review Date: 10/13/2013
Reviewed By: George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team
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