Hepatitis C (HCV)

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What Is Hepatitis?

Hepatitis is an inflammation, or swelling, of the liver. Alcohol, drugs (including street drugs, over-the-counter medications, prescription medications, and complementary or alternative medications), poisons, and several viruses can cause hepatitis. Viral hepatitis is the term used for any inflammation of the liver caused by a virus.

Signs of hepatitis include:

  • Jaundice (yellowing of the skin, eyes, and lining of the mouth)
  • Dark-colored urine ("pee")
  • Stool ("poop") that appears pale and clay-like
  • Fatigue (extreme tiredness)
  • Loss of appetite
  • General aching
  • Nausea (feeling you need to throw up)
  • Diarrhea (you have to poop often and poop is watery)

What Is Hepatitis C (HCV)?

Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). The US Centers for Disease Control and Prevention (CDC) estimates that there are approximately 2.4 million Americans living with chronic (long-lasting) HCV. The World Health Organization (WHO) estimates that 71 million people are chronically infected with HCV worldwide, and almost 400,000 people die from it each year. 

From 15 to 45 percent of people around the world clear (get rid of) HCV from their bodies without medical treatment within the first six months of acquiring HCV. Most people do not clear HCV on their own and go on to develop chronic infection.

Chronic HCV may not cause any symptoms for ten years or more. However, even without symptoms, it can cause serious liver damage leading to cirrhosis (irreversible scarring of the liver), liver failure, and death. In fact, HCV is one of the most common causes of liver disease. Cirrhosis caused by HCV is one of the most common reasons for liver transplants in America.

How Is HCV Spread?

HCV is spread in the following ways:

  • Sharing equipment for injecting drugs
  • Sharing equipment used to snort or smoke drugs (e.g., bills, straws, pipes)
  • Sharing needles or inkwells that are used to apply tattoos
  • Receiving a transfusion of blood, blood products, or organs before 1992 in the US; in some countries, HCV can still be spread through unscreened blood or blood products
  • Having unprotected vaginal or anal sex with someone who has HCV
  • Passing the virus from an infected pregnant woman to her baby (less common)
  • Sharing personal care items that may come in contact with another person's blood, such as razors or toothbrushes (less common)

You cannot get hepatitis C from casual contact with someone (e.g., hugging, kissing, sharing food and drink). HCV is also not spread through breast milk.

Prevention of HCV

Unfortunately, there is still no vaccine to prevent HCV infection. However, there are vaccines for two other types of hepatitis: A and B. People with HCV should get hepatitis A and B vaccinations as soon after their HCV diagnosis as possible. See our fact sheets on hepatitis A and hepatitis B for more information.

Perinatal or mother-to-child transmission of HCV is uncommon. A pregnant woman may pass HCV to her baby in about six out of every hundred cases. Studies have found that the risk of perinatal transmission of HCV is twice as high in women living with HIV. There is currently no known treatment that will prevent the transmission of HCV from mother to child.

The best way to prevent HCV acquisition is to avoid exposure to blood that is infected with HCV. Do not share equipment for using street drugs and make sure tattoo artists use sterile needles and inkwells. Practicing safer sex is also a good idea; you can find tips to protect yourself in our Safer Sex fact sheet.

Testing for HCV

Most people who are living with HCV do not know it because they have no symptoms. Early signs of HCV can seem like the flu and often go unnoticed. The only way to know for sure if you have HCV is to get a blood test for it. Testing for HCV is usually recommended based on a person’s risk of infection or exposure to ways in which HCV is spread (see list above).

In addition, the CDC recommends that everyone in the US born between 1945 and 1965 (the "baby boomers") get a one-time blood test for HCV. This recommendation is based on improvements in treatment for hepatitis C and high rates of HCV infection among baby boomers. The Canadian Liver Foundation has made similar recommendations for testing all adults born between 1945 and 1975.

Tests for HCV include:

  • HCV antibody and nucleic acid tests

If you have HIV, it is important that you be tested for HCV. The standard HCV test looks for antibodies to HCV in your blood. If your HCV antibody test is positive, your body may have been infected with HCV at some point in time. However, this antibody test cannot tell whether you were infected in the past and got rid of the virus, or if you are currently infected.

If your HCV antibody test is positive, you may also get a nucleic acid test (NAT), which tests for the actual genetic material of the hepatitis C virus, also called the HCV RNA. If your NAT is positive, you are currently infected with HCV. If your NAT is negative (no HCV RNA in your blood), then you were infected in the past and your body got rid of the virus on its own or the antibody test was incorrect (a false positive).

If your HCV antibody test is positive, your provider may order an HCV viral load test.

  • Liver enzyme (or liver function) tests

Liver enzyme tests are blood tests that look at levels of liver enzymes (substances that your liver produces to bring about certain biological processes). Because levels of liver enzymes can tell us how well the liver is working, liver enzyme tests are often called liver function tests. Liver enzyme tests measure several substances that the liver produces, including ALT (alanine aminotransferase), AST (aspartate aminotransferase), bilirubin, albumin, and some indicators of your blood's ability to clot. Elevated (higher than normal) liver enzymes may indicate liver damage. However, some people with HCV have normal liver enzymes, even in very advanced disease.

  • Genotype tests

Worldwide, there are six different types of HCV called genotypes. Different genotypes are more common in some regions than others. Genotype 1 is the most common globally (46 out of every 100 infections) and is also the most common in the US. Genotype 3 is very common in Southeast Asia, while genotype 4 is found mostly in the Middle East and central Africa. Genotype 5 is found almost entirely in South Africa, and genotype 6 is found in Asia.

Because different genotypes respond differently to the various treatments, it is important to have a genotype test before you begin HCV treatment. This will help you and your health care provider decide which treatments to use and how long to use them.

  • Liver biopsy

A liver biopsy involves inserting a needle through the skin into the liver to get a small sample that is examined under a microscope. A biopsy is a reliable way to determine how much damage has been done to your liver. It can also help you and your health care provider figure out when to start HCV treatment.

  •  FibroSURE™ (or FibroTest) 

FibroSURE™ is a blood test that looks at six markers of liver activity to measure liver damage. It is often used as a non-invasive alternative (does not involve sticking needles into your body) to liver biopsy. This test is good at identifying either no liver damage or advanced liver damage. However, if the damage is somewhere between none and advanced, the test is not very helpful. A liver biopsy gives more detailed information about all levels of liver damage.

  • FibroScan™

FibroScan is a relatively new non-invasive test that is currently approved for use in 70 countries, including the US. It is similar to an ultrasound exam and is done in the office or clinic by your provider. The scan uses a dull probe (instrument) that is pressed against the skin over the liver. FibroScan is used to measure liver damage and determine the amount of liver fibrosis or scarring. Because the sound waves it uses must pass through body fat, it is not a good test for those who are obese (have a lot of body fat).

Women and Hepatitis C

Women who are living with HCV are different from men living with HCV in a few important ways. First, the good news: women's bodies are more likely to clear HCV on their own than men's bodies. This means that when women become infected with HCV, their bodies are more successful at fighting it off. Women who develop chronic HCV infections are also more likely to get rid of HCV with treatment. Lastly, liver disease tends to progress more slowly in pre-menopausal (still have their periods) women than in men.

However, women with HCV face a few extra challenges compared with HCV-infected men. First, women's livers are more sensitive to alcohol and are therefore more likely to be damaged by smaller amounts of alcohol. For women living with HCV, it is best to avoid alcohol altogether. HCV-positive women who do drink alcohol should have no more than one drink per day.

Secondly, women are more likely to experience side effects when taking the drugs that used to be the standard HCV treatment – pegylated interferon and ribavirin. Specifically, depression and anemia are more common in women than men who take these drugs. The good news is that many new HCV drugs now provide more effective treatment without either interferon or ribavirin, and therefore these older medicines are now rarely used.

Too much body weight can also lead to fat in the liver. Fat in the liver increases inflammation and liver damage and increases the risk of cirrhosis in women living with HCV. Being overweight and having fat in the liver also lowers the chances that HCV treatment will get rid of the hepatitis C virus.

HIV and HCV Co-Infection

Because both HIV and HCV can be spread by contact with infected blood, many people are infected with both viruses. This is called co-infection. The WHO estimates that more than two million people worldwide are co-infected with HIV and HCV. In the US, about one in four people living with HIV are co-infected with HCV. Co-infection is even more common among people who inject street drugs and live with HIV.

HCV can progress more rapidly and lead to serious liver damage more often in people living with HIV. According to the CDC, having HIV more than triples the risk of liver disease, liver failure, and liver-related death due to HCV. Pregnant women with HCV who are also living with HIV are twice as likely to pass HCV on to their babies than HIV-negative women. Co-infection with HCV may also make HIV treatment more challenging.

For these reasons, it is important for people living with HIV to know whether they have HCV. The CDC recommends that all people living with HIV be screened for both hepatitis B and hepatitis C. Some experts recommend that people living with HIV who are at risk for HCV be screened every year.

Treatment of HCV/HIV Co-Infection

Treatment of HIV/HCV co-infection can be complicated. It is important to have a health care provider who is familiar with both viruses. The good news is that HCV can be treated successfully, even in people living with HIV, and that there are several new and effective HCV drugs.

Recent research shows that waiting to treat HCV until a person has serious liver disease makes treatment less effective and death more likely. We also now know that people living with HIV are more likely to develop HCV-related liver damage and do so more quickly than HIV-negative people. If they wait to start HCV treatment, people living with HIV are at risk for liver problems even after they have been cured of HCV. The longer HCV treatment is put off, the worse the outcome.

In the past, when HCV treatment involved interferon, experts often advised waiting with treatment. Now, however, there are several interferon-free treatment options that are much more successful, even in people co-infected with HIV and HCV. These medications are often referred to as DAAs, or direct-acting antiviral agents. 

For more information about HCV treatment, see our fact sheet on the Treatment of Hepatitis C.

Taking Care of Yourself

Because there is no vaccine for HCV, the best way to avoid getting it is to understand how it is spread and protect yourself through safer sex and by using clean needles when injecting. You can also keep your liver healthy by:

See our fact sheet on Caring for Your Liver for more information.

Additional Resources

Select the links below for additional material related to hepatitis C.
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