What is hepatitis?

Hepatitis means inflammation of the liver. When the liver is inflamed or damaged, its function can be affected. Heavy alcohol use, toxins, some medications, and certain medical conditions can all cause hepatitis. However, hepatitis is often caused by a virus. In the United States, the most common hepatitis viruses are hepatitis A virus, hepatitis B virus, and hepatitis C virus.

What is the difference between hepatitis A, hepatitis B, and hepatitis C?

Hepatitis A, hepatitis B, and hepatitis C are liver infections caused by three different viruses. Although each can cause similar symptoms, they are spread in different ways and can affect the liver differently. Hepatitis A is usually a short-term infection. Hepatitis B and hepatitis C can also begin as short-term infections but in some people, the virus remains in the body, and causes chronic (lifelong) infection. There are vaccines to prevent hepatitis A and hepatitis B; however, there is no vaccine for hepatitis C.
The page “What is viral hepatitis?” explains in detail the differences between hepatitis A, hepatitis B, and hepatitis C.

What is hepatitis C?

Hepatitis C is a liver infection caused by the hepatitis C virus. Hepatitis C can range from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis C is often described as “acute,” meaning a new infection or “chronic,” meaning lifelong infection.

• Acute hepatitis C occurs within the first 6 months after someone is exposed to the hepatitis C virus. Hepatitis C can be a short-term illness, but for most people, acute infection leads to chronic infection.
• Chronic hepatitis C can be a lifelong infection with the hepatitis C virus if left untreated. Left untreated, chronic hepatitis C can cause serious health problems, including liver damage, cirrhosis (scarring of the liver), liver cancer, and even death.

What is the likelihood that acute hepatitis C will become chronic?

Approximately 75%–85% of people who become infected with hepatitis C virus will develop a chronic infection.

Is it possible to clear the hepatitis C virus?

Yes, approximately 15%–25% of people who are infected with the hepatitis C virus clear it from their bodies without treatment and do not develop chronic infection. Experts do not fully understand why this happens for some people.

Statistics

How common is acute hepatitis C in the United States?

In 2016, a total of 2,967 cases of acute hepatitis C were reported to CDC. Since many people may not have symptoms or don’t know they are infected, their illness is often not diagnosed or reported and therefore can’t be counted. CDC estimates the actual number of acute hepatitis C cases was almost 41,200 in 2016.

How common is chronic hepatitis C in the United States?

In 2016, there were an estimated 2.4 million people living with hepatitis C in the United States.

Transmission / Exposure

How is hepatitis C spread?

Hepatitis C is usually spread when blood from a person infected with the hepatitis C virus enters the body of someone who is not infected. Today, most people become infected with the hepatitis C virus by sharing needles or other equipment to prepare or inject drugs. Before 1992, hepatitis C was also commonly spread through blood transfusions and organ transplants. After that, widespread screening of the blood supply in the United States virtually eliminated this source of infection.

People can become infected with the hepatitis C virus during such activities as:

• Sharing needles, syringes, or other equipment to prepare or inject drugs
• Needlestick injuries in health care settings
• Being born to a mother who has hepatitis C

Less commonly, a person can also get hepatitis C virus through

• Sharing personal care items that may have come in contact with another person’s blood, such as razors or toothbrushes
• Having sexual contact with a person infected with the hepatitis C virus
• Getting a tattoo or body piercing in an unregulated setting

Hepatitis C virus is not spread by sharing eating utensils, breastfeeding, hugging, kissing, holding hands, coughing, or sneezing. It is also not spread through food or water.

Can I be re-infected with hepatitis C virus if I have cleared the virus?

Yes. If you have been infected with the hepatitis C virus and cleared the virus, or if you have been successfully treated and cured, you can be re-infected with the hepatitis C virus.

Can hepatitis C virus be spread through sexual contact?

Yes, but the risk of transmission from sexual contact is believed to be low. The risk increases for people who have multiple sex partners, have a sexually transmitted disease, engage in rough sex, or are infected with HIV.

Can you get hepatitis C by getting a tattoo or piercing?

A few major research studies have not shown hepatitis C to be spread through licensed, commercial tattooing facilities. However, transmission of hepatitis C (and other infectious diseases) is possible when poor infection-control practices are used during tattooing or piercing. Unregulated tattooing and piercing are known to occur in prisons and other informal settings and may put a person at risk of infection.

Can hepatitis C be spread within a household?

Yes, but this does not occur very often. If hepatitis C virus is spread within a household, it is most likely a result of direct, through-the-skin exposure to the blood of an infected household member.

Who is at risk for hepatitis C?

Some people are at increased risk for having hepatitis C, including:

• Current or former injection drug users, including those who injected only once many years ago
• Those born from 1945 through 1965
• Recipients of clotting factor concentrates made before 1987, when less advanced methods for manufacturing those products were used
• Recipients of blood transfusions or solid organ transplants prior to July 1992, before better testing of blood donors became available
• Hemodialysis patients
• People with known exposures to the hepatitis C virus, such as

• • Health care workers after needle sticks involving blood from someone who is infected with the hepatitis C virus
  • Recipients of blood or organs from a donor who tested positive for the hepatitis C virus

• People with HIV infection
• Children born to mothers infected with the hepatitis C virus
• People who are incarcerated
• People who use intranasal drugs
• People who received body piercing or tattoos done with non-sterile instruments

What is the risk of a pregnant woman passing hepatitis C to her baby?

About 6 in 100 infants born to mothers with hepatitis C become infected with the hepatitis C virus. However, the risk becomes greater if the mother has both HIV and hepatitis C.

Can a person get hepatitis C virus from a mosquito or other insect bite?

No, the hepatitis C virus has not been shown to be transmitted by mosquitoes or other insects.

Can I donate blood if I have tested positive for hepatitis C?

The American Red Cross does not accept blood donations from anyone with current signs or symptoms of hepatitis, or if you have ever tested positive for hepatitis C.

Can someone with hepatitis C donate organs?

According to the U.S. Department of Health & Human Service’s online information on organ donation and transplantation, very few conditions would prevent someone from being an organ, eye, or tissue donor. Even with acute or chronic hepatitis C, you may be able to donate your organs or tissues. The transplant team will determine what organs or tissue can be used based on a clinical evaluation, medical history and other factors.

Symptoms

What are the symptoms of acute hepatitis C?

People with new (acute) hepatitis C virus infection usually do not have symptoms or have mild symptoms. When symptoms do occur, they can include:

• Fever
• Fatigue
• Dark urine
• Clay-colored bowel movements
• Abdominal pain
• Loss of appetite
• Nausea
• Vomiting
• Joint pain
• Jaundice (yellow color in the skin or eyes)

How soon after exposure to hepatitis C virus do symptoms appear?

In those people who develop symptoms from acute infection, the average time from exposure to symptoms ranges from 2 to 12 weeks. However, most people who are infected with the hepatitis C virus do not develop symptoms.

Can a person spread hepatitis C without having symptoms?

Yes, even if a person with hepatitis C has no symptoms, he or she can still spread the hepatitis C virus to others.

Is it possible to have hepatitis C and not know it?

Yes, many people who are infected with the hepatitis C virus do not know they are infected because they do not look or feel sick.

What are the symptoms of chronic hepatitis C?

Most people with chronic hepatitis C virus infection do not have any symptoms or have general, or common symptoms such as chronic fatigue and depression. Many people eventually develop chronic liver disease, which can range from mild to severe, including cirrhosis (scarring of the liver) and liver cancer. Chronic liver disease in people with hepatitis C usually happens slowly, without any signs or symptoms, over several decades. Chronic hepatitis C virus infection is often not recognized until people are screened for blood donation or from an abnormal blood test found during a routine examination.

How serious is chronic hepatitis C?

Chronic hepatitis C can be a serious disease resulting in long-term health problems, including liver damage, liver failure, liver cancer, or even death. It is a major cause of cirrhosis and liver cancer and the most common reason for liver transplantation in the United States. There were 18,153 deaths related to hepatitis C virus reported to CDC in 2016, but this is believed to be an underestimate.

What are the long-term effects of hepatitis C?

Of every 100 people infected with hepatitis C virus:

• 75-85 will develop chronic infection
• 10-20 will develop cirrhosis over 20-30 years

Among 100 people with hepatitis C and cirrhosis, with each passing year:

• 3-6 will develop liver failure
• 1-5 will develop liver cancer

Developing cirrhosis is more likely if you are male, age 50 years and older, use alcohol, have nonalcoholic fatty liver disease, hepatitis B virus or HIV coinfection, or take immunosuppressive drugs.

Tests

Who should get tested for hepatitis C?

CDC recommends hepatitis C testing for:

• Current or former injection drug users, including those who injected only once many years ago
• Everyone born from 1945  to 1965
• Anyone who received clotting factor concentrates made before 1987
• Recipients of blood transfusions or solid organ transplants prior to July 1992
• Long-term hemodialysis patients
• People with known exposures to the hepatitis C virus, such as
  • health care workers or public safety workers after needle sticks involving blood from someone infected with hepatitis C virus
  • recipients of blood or organs from a donor who tested positive for the hepatitis C virus
• People with HIV infection
• Children born to mothers with hepatitis C

Other experts, including a group that helps set health policies in the United States, called the U.S. Preventive Services Task Force (USPSTF) recommends hepatitis C virus testing for additional groups including:

• People in jails or prisons
• People who use drugs snorted through the nose (in addition to people who inject drugs),

People who get an unregulated tattoo

If I am pregnant, should I be tested for hepatitis C?

Getting tested for hepatitis C is not part of routine prenatal care. However, if you are a pregnant woman who has risk factors for hepatitis C virus infection, you should speak to your doctor about getting tested.

Should a woman with hepatitis C virus infection avoid breastfeeding?

No. There is no evidence that breastfeeding spreads hepatitis C virus. Precautions may be considered if a mothers with hepatitis C has cracked or bleeding nipples because there is not enough information on the risks of transmission when this happens.

What blood tests are used to test for hepatitis C?

The only way to know if you have hepatitis C is to get tested and you may need more than one type of test. A blood test, called a hepatitis C antibody test, can tell if you have ever been infected with the hepatitis C virus. Antibodies are chemicals released into the bloodstream when someone gets infected. Another test, called a hepatitis C virus RNA test, can tell if you have a current infection with the hepatitis C virus. RNA is the virus’ genetic material.

What blood tests are used to test for hepatitis C?

The only way to know if you have hepatitis C is to get tested and you may need more than one type of test. A blood test, called a hepatitis C antibody test, can tell if you have ever been infected with the hepatitis C virus. Antibodies are chemicals released into the bloodstream when someone gets infected. Another test, called a hepatitis C virus RNA test, can tell if you have a current infection with the hepatitis C virus. RNA is the virus’ genetic material.

How do I interpret the results of hepatitis C anti-body test?

There are two possible antibody test results:

• Non-reactive, or a negative, means that a person has never had hepatitis C. However, if a person has been recently exposed to the hepatitis C virus, he or she will need to be tested again.
• Reactive, or a positive, means that hepatitis C antibodies were found in the blood and a person has been infected with the hepatitis C virus at some point in time. A reactive antibody test does not necessarily mean a person has hepatitis C. Once someone has been infected, they will always have antibodies in their blood. This is true if even if they have cleared the hepatitis C virus.

A reactive antibody test requires an additional test, called a hepatitis C virus RNA test (or PCR), to confirm whether the virus is still present in the person’s bloodstream.

How soon after exposure to the hepatitis C virus can the antibody test tell if someone is infected?

For most people exposed to the hepatitis C virus, the HCV antibody blood test will be positive in 4–10 weeks. About 97% of people infected will have a positive HCV antibody test 6 months after exposure.

How soon after exposure to the hepatitis C virus can hepatitis C virus be detected by a hepatitis C virus RNA (PCR) test?

A special kind of blood test called a hepatitis C virus RNA test (or PCR) can tell if a person is infected in 2–3 weeks after exposure.

Can a person have normal liver enzyme (e.g., ALT) level and still have hepatitis C?

Yes. It is common for persons with chronic hepatitis C to have a liver enzyme level that goes up and down, with periodic returns to normal or near normal. Some people with hepatitis C have liver enzyme levels that are normal for over a year even though they have chronic liver disease.

Treatment

What is the treatment for acute hepatitis C?

There is not a recommended treatment for acute hepatitis C. People with acute hepatitis C virus infection should be followed by a doctor and only considered for treatment if their infection remains and becomes a chronic infection.

What is the treatment for chronic hepatitis C?

There are several medications available to treat chronic hepatitis C. Hepatitis C treatments have gotten much better in recent years. Current treatments usually involve just 8-12 weeks of oral therapy (pills) and cure over 90% of people with few side effects. For a complete list of currently approved FDA treatments for hepatitis C, please visit http://www.hepatitisc.uw.edu/page/treatment/drugs.

What can a person with chronic hepatitis C do to take care of his or her liver?

First, people with chronic hepatitis C should talk to their doctor about treatments, even if they have been treated for hepatitis C in the past. For people with cirrhosis, there is a continued risk of liver cancer even after hepatitis C virus infection is cured. People with chronic hepatitis C, and people with cirrhosis (even if they have been cured for hepatitis C) should be monitored regularly by a doctor and be vaccinated against hepatitis A and hepatitis B. People with chronic hepatitis C should avoid alcohol because it can cause additional liver damage. They also should check with their doctor before taking any prescription pills, herbs, supplements, or over-the-counter medications, as these can potentially damage the liver.

Vaccination

Is there a vaccine that can prevent hepatitis C?

No. Research into the development of a vaccine for hepatitis C is under way. Vaccines are available for hepatitis A and hepatitis B.

Hepatitis C and Employment

Should a person infected with the hepatitis C virus be restricted from working in certain jobs or settings?

CDC’s recommendations for prevention and control of the hepatitis C virus infection state that people should not be excluded from work, school, play, child care, or other settings because they have hepatitis C virus infection. There is no evidence that people can get hepatitis C from food handlers, teachers, or other service providers without blood-to-blood contact.

Hepatitis C and Co-infection with HIV

Can a person be infected with HIV and the hepatitis C virus?

Yes, a person can be infected with both HIV and hepatitis C virus. This is sometimes called “coinfection.” To learn more about coinfection, read HIV and Viral Hepatitis[PDF – 2 pages].

 

SOURCE: CDC