Overview
Hepatitis C is inflammation and scarring of the liver caused by a virus that spreads through blood. Most people feel nothing at first, and WHO reports that around 70% of those infected keep the virus long term while it slowly damages the liver.
The important development is that hepatitis C is now curable. WHO states that direct-acting antiviral tablets cure more than 95% of people, usually in 8 to 12 weeks. The difficulty is finding people who do not know they have it.
Disease Summary
- Category
- Infectious Disease
- Cause
- Hepatitis C virus
- Transmission
- Blood-to-blood contact
- Body System
- Liver
- Preventable
- Yes
- Curable
- Yes
Symptoms
Common Symptoms
CDC states that many people with hepatitis C have no symptoms and do not know they are infected, and that serious signs of liver damage may not appear for 20 years or more.
Often No Symptoms at All
This is the most important thing to understand about hepatitis C. Most people feel entirely well while the virus is present.
Tiredness
Persistent fatigue is the symptom people most often report when they do have any.
Fever
Listed by both WHO and CDC among the symptoms of the early phase of infection.
Loss of Appetite, Nausea and Stomach Pain
Grouped together by CDC as symptoms of acute infection.
Jaundice
Yellowing of the skin or the whites of the eyes, which indicates active liver inflammation.
Dark Urine or Pale Stools
Often noticed before the skin changes colour.
Joint Pain
Listed by both WHO and CDC among the symptoms of hepatitis C.
Symptoms Appearing Long After Exposure
CDC states that symptoms can appear any time from 2 weeks to 6 months after exposure, and that serious liver damage may take over 20 years to show.
Danger Signs
Seek urgent medical attention immediately if any of the following symptoms develop.
Jaundice
Yellowing of the skin or eyes means active liver inflammation and needs assessment.
Signs of Liver Failure
Confusion, drowsiness, swelling of the abdomen or unusual bleeding all indicate the liver is failing and are emergencies.
Vomiting Blood or Black Stools
These indicate bleeding from enlarged veins in the gullet, a complication of advanced liver scarring.
Swelling of the Legs or Abdomen
Fluid accumulation is a sign of advanced liver disease and needs specialist care.
New Fever With Abdominal Pain in Known Chronic Infection
This combination needs prompt assessment in anyone with existing liver disease.
Diagnosis
Testing Everyone, Not Just People With Symptoms
CDC recommends screening all adults aged 18 and older at least once, and all pregnant patients in each pregnancy. WHO recommends general population testing in settings where more than 2% of people carry the antibody.
The Two-Step Testing Process
An antibody test comes first. If it is reactive, a second test looks for the virus itself. Only the second test shows whether the infection is still present.
Assessment for Liver Disease
Examination and blood tests look for signs of liver damage, which shapes how urgently treatment is needed.
Staging the Liver Scarring
WHO recommends assessing how much scarring is present, using blood tests or a scan, because it guides treatment length and follow-up.
Looking for Effects Beyond the Liver
CDC notes that hepatitis C can affect the kidneys, blood, skin and hormones, so these are considered too.
Laboratory Tests
Hepatitis C Antibody Test, Rapid Format
Shows whether you have ever been infected. A reactive result always needs confirming with a test for the virus itself.
Hepatitis C Antibody Test, Laboratory Format
The same question answered in a laboratory. A non-reactive result means you are not currently infected.
Hepatitis C RNA Test
The test that decides. A positive result means the virus is present now. A negative result after a reactive antibody test means a past infection that has cleared.
Liver Function Tests
Shows whether the liver is inflamed or damaged. Normal results do not exclude infection.
Liver Scarring Assessment
Establishes how much scarring has developed. WHO recommends this to guide treatment and follow-up.
Treatment
Direct-Acting Antiviral Tablets
WHO states these cure more than 95% of people with hepatitis C, whatever the strain of the virus. They are taken as tablets, usually once a day, and side effects are generally mild.
Treatment for Children and Adolescents Too
WHO recommends treatment with these tablets for all adults, adolescents and children down to 3 years of age.
Assessment Before and After Treatment
WHO recommends assessing liver scarring to decide treatment length and to identify who needs continued monitoring afterwards.
Confirming the Cure
A test for the virus after treatment confirms that it has gone. This is what a cure means in practice.
Continued Monitoring Where Scarring Is Advanced
People who already had significant scarring stay under surveillance after cure, because the risk of liver cancer does not disappear immediately.
Prevention
Safe injections and safe handling of sharps
WHO lists safe injection practices and safe disposal of needles and medical waste as core prevention measures.
Screening of donated blood
Screening blood and organ donors removes one of the historically important routes of transmission.
Harm reduction for people who inject drugs
WHO lists needle and syringe programmes and opioid substitution treatment among the measures that reduce transmission.
Do not share razors, toothbrushes or nail clippers
CDC names these specifically, because they can carry traces of blood.
Use properly sterilised equipment for tattoos and piercings
CDC advises against unregulated tattooing and piercing and recommends sterilised equipment.
Get tested
There is no vaccine for hepatitis C, so finding and curing infection is the main way the chain of transmission is broken.
Risk Factors
People Who Inject Drugs
Both WHO and CDC name this as the group carrying the greatest risk in many countries.
- Sharing needles, syringes or any other injecting equipment
- Even microscopic amounts of blood can transmit the virus
- CDC recommends repeated rather than one-off testing for this group
- Harm reduction services substantially reduce transmission
People Exposed Through Health Care
WHO names unsafe medical procedures and unscreened blood among the transmission routes.
- Anyone who received a transfusion before donor screening was in place
- People who had injections with reused equipment
- Health workers after a needlestick injury
- People who had dialysis where infection control was inadequate
Pregnant Women and Children
Transmission from mother to baby is possible, though less common than other routes.
- CDC recommends testing in every pregnancy
- Babies born to mothers with hepatitis C are tested after birth
- WHO recommends treatment for children from 3 years of age
- A cure in the mother before a future pregnancy removes the risk
Other Groups WHO Recommends Testing
WHO names several groups where infection rates are higher than average.
- People in prisons and other closed settings
- Migrants from regions where the virus is common
- People living with HIV or tuberculosis
- Anyone with unexplained abnormal liver blood tests
Complications
Long-Term Infection
WHO reports that chronic infection develops in around 70% of people infected, typically without any symptoms for years.
Liver Scarring
WHO reports that 15% to 30% of people with chronic hepatitis C develop cirrhosis within 20 years if untreated.
Liver Cancer
CDC reports that people with hepatitis C and cirrhosis carry a 1% to 4% annual risk of liver cancer.
Liver Failure
Advanced scarring can progress to failure of the liver, which may require transplantation.
Effects Outside the Liver
CDC names kidney inflammation, certain blood and skin conditions, diabetes and some lymphomas among the conditions linked to hepatitis C.
Silent Progression
CDC states that serious signs of liver damage might not show up for 20 years or more, which is precisely why testing matters.
When to Seek Medical Care
To Be Tested, Even Without Symptoms
CDC states that because many people have no symptoms, testing is the best way to diagnose hepatitis C.
After Any Possible Blood Exposure
A needlestick, a shared needle, or a medical procedure where sterility is uncertain are all reasons to be tested.
During Every Pregnancy
CDC recommends screening in each pregnancy.
If Jaundice, Dark Urine or Pale Stools Appear
These indicate active liver inflammation and need assessment.
If You Know You Have Hepatitis C but Have Never Been Treated
WHO reports that only about 20% of people diagnosed have been treated. Treatment cures more than 95%, so this is worth pursuing.
Prognosis
Some People Clear It Without Treatment
WHO reports spontaneous clearance in about 30% of people within 6 months of infection.
Treatment Cures More Than 95%
Both WHO and CDC state that direct-acting antivirals cure more than 95% of people, in 8 to 12 weeks of oral treatment.
Untreated Infection Carries Real Risk
WHO reports cirrhosis in 15% to 30% of people within 20 years, and CDC reports a 1% to 4% annual liver cancer risk once cirrhosis is present.
Cure Does Not Undo Existing Scarring
People treated after significant scarring has developed still need monitoring, which is another argument for earlier testing.
Differential Diagnosis
Hepatitis B
Another bloodborne liver infection with similar long-term risks, separated by hepatitis B specific blood tests. Hepatitis B has a vaccine, hepatitis C does not.
Hepatitis A
Causes an acute illness that looks similar at first but never becomes chronic, and is separated by hepatitis A antibody testing.
Alcohol-Related Liver Disease
Produces the same end-stage picture of scarring and liver failure, separated by drinking history and a negative test for the virus.
Fatty Liver Disease
Also causes raised liver enzymes and scarring without symptoms, and is separated by negative hepatitis C testing and by imaging.
A Past Infection That Has Cleared
Looks identical on the antibody test. CDC states that a reactive antibody test with a negative virus test means past infection that is no longer present.
References
World Health Organization: Hepatitis C
WHO fact sheet on transmission, testing, treatment, prevention and global burden.
CDC: Hepatitis C Basics
Overview of transmission, symptoms, complications and treatment.
CDC: Testing for Hepatitis C
Who should be tested, the two-step testing process and how to read the results.
CDC: Clinical Overview of Hepatitis C
Natural history, complication rates and effects outside the liver.
Frequently Asked Questions
Can hepatitis C be cured?
Yes. WHO and CDC both state that direct-acting antiviral tablets cure more than 95% of people. Treatment is usually 8 to 12 weeks of oral medicine and works regardless of which strain of the virus a person has.
Is there a hepatitis C vaccine?
No. CDC states plainly that there is no vaccine to prevent hepatitis C. Prevention relies on safe injections, screened blood, not sharing items that may carry blood, and harm reduction, alongside finding and curing existing infections.
How would I know if I have hepatitis C?
Usually you would not. CDC states that many people have no symptoms and do not know they are infected, and that serious liver damage might not show for 20 years or more. This is why CDC recommends every adult be tested at least once.
Can I catch hepatitis C from kissing, food or sharing a cup?
No. WHO states that hepatitis C is not transmitted through breast milk, food, water or casual contact. It spreads when blood from an infected person enters the body of someone who is not infected.
Does a positive antibody test mean I have the virus now?
Not necessarily. CDC states that a reactive antibody test means you have been infected at some point in your life. A follow-up test for the virus itself decides: positive means you are infected now, negative means you were infected before but the virus is no longer present. WHO reports that about 30% of people clear it on their own.