Hepatitis C

Symptoms

Hepatitis C infection usually produces no signs or symptoms during its earliest stages. When signs and symptoms do occur, they're generally mild and flu-like and may include:

• Fatigue
• Fever
• Nausea or poor appetite
• Muscle and joint pains
• Tenderness in the area of your liver

When to see a doctor 

Make an appointment with your doctor if you have any signs and symptoms that worry you.

Causes

Hepatitis C infection is caused by the hepatitis C virus (HCV). HCV is spread when you come in contact with contaminated blood.

Examples of how HCV can be spread include:

• Blood transfusions and organ transplants before 1992.Improved blood-screening tests became available in 1992. Before that year, it was possible to unknowingly contract hepatitis C through a blood transfusion or organ transplant.
• Shared needles. HCV can also spread through sharing contaminated needles when injecting drugs.
• Childbirth. A small number of babies born to mothers with hepatitis C acquire the infection during childbirth.
• Sexual contact. In rare cases, HCV may be transmitted sexually.

Risk factors

Your risk of hepatitis C infection is increased if you:

• Are a health care worker who has been exposed to infected blood
• Have ever injected illicit drugs
• Have HIV
• Received a piercing or tattoo in an unclean environment using unsterile equipment
• Received a blood transfusion or organ transplant before 1992
• Received clotting factor concentrates before 1987
• Received hemodialysis treatments for a long period of time
• Were born to a woman with a hepatitis C infection

Complications

Hepatitis C infection that continues over many years can cause significant complications, such as:

• Scarring of the liver tissue (cirrhosis). After 20 to 30 years of hepatitis C infection, cirrhosis may occur. Scarring in your liver makes it difficult for your liver to function.
• Liver cancer. A small number of people with hepatitis C infection may develop liver cancer.
• Liver failure. A liver that is severely damaged by hepatitis C may be unable to function.

Preparing for your appointment

Who to see 

If you think you may have a risk of hepatitis C, see your family doctor or a general practitioner. Once you've been diagnosed with hepatitis C infection, your doctor may recommend you see a specialist. Specialists who see people with hepatitis C infection include:

• Doctors who specialize in infectious diseases
• Doctors who specialize in liver diseases (hepatologists)

How to prepare 

Because appointments can be brief and because there's often a lot of ground to cover, it's a good idea to be well prepared. To prepare, try to:

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.

Tests and diagnosis

Screening for hepatitis C 

Testing for hepatitis C infection in people who have a high risk of coming in contact with the virus may help doctors begin treatment or recommend lifestyle changes that may slow liver damage. This is recommended because hepatitis C infection often begins damaging the liver before it causes signs and symptoms.

People who may want to talk to their doctors about screening for hepatitis C infection include

Treatments and drugs

Treatment isn't always necessary 

A diagnosis of hepatitis C infection doesn't necessarily mean you need treatment. If you have only slight liver abnormalities, you may not need treatment, because your risk of future liver problems is very low. Your doctor may recommend follow-up blood tests to monitor for liver problems.

Antiviral medications 

Hepatitis C infection is treated with antiviral medications intended to clear the virus from your body. Your doctor may recommend a combination of medications taken over several weeks. Once you complete a course of treatment, your doctor will test your blood for the hepatitis C virus. If hepatitis C is still present, your doctor may recommend a second round of treatment.

Antiviral medications can cause depression and flu-like signs and symptoms, such as fatigue, fever and headache. Some side effects can be serious enough that treatment must be delayed or stopped in certain cases.

Liver transplant 

If your liver has been severely damaged, a liver transplant may be an option. During a liver transplant, the surgeon removes your damaged liver and replaces it with a healthy liver. Most transplanted livers come from deceased donors, though a small number come from living donors who donate a portion of their livers.

For people with hepatitis C infection, a liver transplant is not a cure. Treatment with antiviral medications usually continues after a liver transplant, since hepatitis C infection is likely to recur in the new liver.

Vaccinations to protect against other forms of viral hepatitis 

Your doctor will likely recommend that you receive vaccines against the hepatitis A and B viruses. These are separate viruses that also can cause liver damage and complicate treatment of hepatitis C.