Hepatitis C is an infection that causes inflammation of the liver. The illness can be quite mild and short lived, or it can become chronic. The main method of transmission is contact with the blood of an infected person. Diagnosis is made through blood testing.
Hepatitis C can be successfully treated with antiviral medications, but chronic hepatitis C can severely damage the liver over time. Currently, there is no vaccination for this condition.
Types of Hepatitis
There are five main types of hepatitis virus: A, B, C, D, and E. They all attack the liver, but there are distinct differences.
Hepatitis C (HCV)
HCV, one of the more serious types of hepatitis, spreads through exposure to infected blood. Sharing needles can spread HCV.
You can also get it from contaminated medical products during transfusions or other medical procedures. However, it’s rarely transmitted this way in the United States these days.
Rarely, it can be sexually transmitted. HCV can be short-term (acute) or long-term (chronic). There is currently no vaccine to prevent HCV.
Hepatitis A (HAV)
HAV can be found in the feces of those who are infected. It usually spreads in contaminated food or water. It may also be transmitted through sexual contact. It’s fairly common in areas of the world that have poor sanitation.
Most of the time, illness caused by HAV is mild, but it can become life threatening. It’s an acute infection that doesn’t become chronic.
There are often no symptoms of HAV, so the number of cases may be under reported. In the United States, there were about 25,000 new cases in 2007, according to the Centers for Disease Control and Prevention (CDC). Vaccination can prevent HAV.
Hepatitis B (HBV)
HBV is spread through infected body fluids, including blood and semen. It can be passed from mother to baby during birth. Shared needles and contaminated medical supplies can also transmit HBV.
The CDC estimates that 800,000 to 1.4 million people in the United States have chronic HBV. There is a vaccine to prevent it.
Hepatitis D (HDV)
You can only get HDV if you’re already infected with HBV. The HBV vaccine protects you from HDV infection.
Hepatitis E (HEV)
HEV is transmitted via contaminated food or water. It’s quite common in the developing world where sanitization is a problem. There is a vaccine to prevent HEV, but according to the World Health Organization (WHO), it’s not yet widely available.
According to the CDC, in 2009, there were about 16,000 reported cases of acute HCV. Approximately 3.2 million people in the United States are living with chronic HCV.
HCV can be found throughout the world. Regions with the highest rates of HCV include Central and East Asia and Northern Africa. According to WHO, types C and B cause chronic illness for hundreds of millions of people around the world.
According to WHO:
- 15–45 percent of people infected with HCV get better within six months without ever receiving treatment.
- Many people are unaware they’re infected.
- 55–85 percent will develop chronic HCV infection.
- For people with chronic HCV infection, the chance of developing cirrhosis of the liver is 15–30 percent within 20 years.
- 130–150 million people around the world are living with chronic HCV.
- Treatment with antiviral medications can cure HCV in many cases, but in some parts of the world, access to the necessary medical care is lacking.
- Antiviral treatment can reduce risk of cirrhosis of the liver and liver cancer.
- Antiviral treatment works for 50–90 percent of people treated.
- 350,000–500,000 people die from HCV-related complications each year.
HCV Risk Factors
Some groups of people have an increased risk of developing HCV. And certain behaviors can also increase your risk of developing HCV. Groups and behaviors with increased risks include:
- intravenous drug users who share contaminated needles
- people who have received contaminated blood products. (Since new screening procedures were implemented in 1992, this is a rare occurrence in the United States.)
- people who get body piercings or tattoos with instruments that have not been properly sterilized
- health care workers who are accidentally stuck with infected needles
- people living with HIV
- newborns whose mothers are HCV positive
It happens infrequently, but it’s also possible to transmit HCV through sexual contact or sharing personal items like razors or toothbrushes if they touch blood.
It’s possible to have HCV and not know it. According to the CDC, 70 to 80 percent of people with acute HCV don’t show symptoms. You can be infected for years before the first symptoms appear, or you can begin to show symptoms between one and three months after infection.
Symptoms can include:
- yellowing skin and eyes (jaundice)
- dark urine
- light-colored stools
- nausea, vomiting, abdominal pain, and discomfort
- loss of appetite
- extreme fatigue
Among those infected with HCV, 75 to 85 percent will go on to develop chronic illness. According to CDC figures, of those:
- 60–70 percent will develop chronic liver disease
- 5–20 percent will develop cirrhosis of the liver in 20–30 years
- 1–5 percent will die from cirrhosis or liver cancer
In about 15-25 percent of cases, acute HCV infection clears up without treatment, according to the CDC. It’s unclear why this happens.
Early treatment can lower your risk of developing chronic HCV. Antiviral medications work to eradicate the virus. You may need to take them for several months.
If you have HCV, you should see your doctor regularly so your condition can be monitored. You can help keep your liver healthy by avoiding alcohol. Some medications — even those sold over the counter — can damage your liver. You should check with your doctor before taking medicines or dietary supplements. Ask your doctor if you should be vaccinated for hepatitis A and B. Blood tests will help your doctor assess the health of your liver over time.
You should also take care not to transmit the virus to others. Keep cuts and scrapes covered. Don’t share personal items like your toothbrush or nail clippers. Don’t donate blood or semen. Tell all your health care providers that you have the virus before they treat you.
If you’ve suffered severe liver damage, you may need a liver transplant. However, this is not a cure. The virus can attack your new liver. It’s likely you’ll still need antiviral medication.
Other Surprising Facts
HCV can be passed from mother to baby during birth, but it’s rare. It’s much more likely to be transmitted this way when the mother also has HIV. About four out of every 100 babies born to an HCV-positive mother will get the infection, according to the CDC.
Other surprising facts:
- Twenty-five percent of people with HIV also have HCV.
- Two to 10 percent of people with HCV also have HBV.
- HCV tends to progress faster in people with HIV.
- HCV is one of the top causes of liver disease, liver transplants, and the leading cause of death from liver disease.
- About 75 percent of adults with HCV are of the “baby boomer” generation.
- Chronic liver disease, which is often due to HCV, is a leading cause of death for African Americans.
- Rates of chronic HCV are higher for African Americans than for people of other ethnicities.
- HCV is not transmitted through coughing, sneezing, or being in close proximity to someone with HCV.
- HCV doesn’t pass through breast milk.
What is hepatitis?
“Hepatitis” means inflammation of the liver. Toxins, certain drugs, some diseases, heavy alcohol use, and bacterial and viral infections can all cause hepatitis. Hepatitis is also the name of a family of viral infections that affect the liver; the most common types are Hepatitis A, Hepatitis B, and Hepatitis C.
What is the difference between Hepatitis A, Hepatitis B, and Hepatitis C?
Hepatitis A, Hepatitis B, and Hepatitis C are diseases caused by three different viruses. Although each can cause similar symptoms, they have different modes of transmission and can affect the liver differently. Hepatitis A appears only as an acute or newly occurring infection and does not become chronic. People with Hepatitis A usually improve without treatment. Hepatitis B and Hepatitis C can also begin as acute infections, but in some people, the virus remains in the body, resulting in chronic disease and long-term liver problems. There are vaccines to prevent Hepatitis A and B; however, there is not one for Hepatitis C. If a person has had one type of viral hepatitis in the past, it is still possible to get the other types.
What is Hepatitis C?
Hepatitis C is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness that attacks the liver. It results from infection with the Hepatitis C virus (HCV), which is spread primarily through contact with the blood of an infected person. HCV can be either “acute” or “chronic.”
Acute Hepatitis C virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the HCV. For most people, acute infection leads to chronic infection.
Chronic Hepatitis C virus infection is a long-term illness that occurs when the Hepatitis C virus remains in a person’s body. Hepatitis C virus infection can last a lifetime and lead to serious liver problems, including cirrhosis (scarring of the liver) or liver cancer.
How common is acute Hepatitis C in the United States?
In 2014, there were an estimated 30,500 cases of acute hepatitis C virus infections reported in the United States.
How common is chronic Hepatitis C in the United States?
An estimated 2.7-3.9 million people in the United States have chronic hepatitis C.
How likely is it that acute Hepatitis C will become chronic?
Approximately 75%–85% of people who become infected with HCV develop chronic infection.
Transmission / Exposure
How is Hepatitis C spread?
Hepatitis C is usually spread when blood from a person infected with the HCV enters the body of someone who is not infected. Today, most people become infected with the HCV by sharing needles or other equipment to inject drugs. Before 1992, when widespread screening of the blood supply began in the United States, Hepatitis C was also commonly spread through blood transfusions and organ transplants.
People can become infected with the Hepatitis C virus during such activities as
- Sharing needles, syringes, or other equipment to inject drugs
- Needlestick injuries in health care settings
- Being born to a mother who has HCV
Less commonly, a person can also get Hepatitis C virus infection 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
Can Hepatitis C be spread through sexual contact?
Yes, but the risk of transmission from sexual contact is believed to be low. The risk increases for those who have multiple sex partners, have a sexually transmitted disease, engage in rough sex, or are infected with HIV. More research is needed to better understand how and when HCV can be spread through sexual contact.
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 HCV (and other infectious diseases) is possible when poor infection-control practices are used during tattooing or piercing. Body art is becoming increasingly popular in the United States, and unregulated tattooing and piercing are known to occur in prisons and other informal or unregulated settings. Further research is needed to determine if these types of settings and exposures are responsible for Hepatitis C virus transmission.
Can Hepatitis C be spread within a household?
Yes, but this does not occur very often. If HCV 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.
How should blood spills be cleaned from surfaces to make sure that Hepatitis C virus is gone?
Any blood spills — including dried blood, which can still be infectious — should be cleaned using a dilution of one part household bleach to 10 parts water. Gloves should be worn when cleaning up blood spills.
How long does the Hepatitis C virus survive outside the body?
The HCV can survive outside the body at room temperature, on environmental surfaces, for up to 3 weeks.
What are ways Hepatitis C is not spread?
HCV is not spread by sharing eating utensils, breastfeeding, hugging, kissing, holding hands, coughing, or sneezing. It is also not spread through food or water.
Who is at risk for Hepatitis C?
Some people are at increased risk for Hepatitis C, including:
- Current injection drug users (currently the most common way HCV is spread in the United States)
- Past injection drug users, including those who injected only one time or many years ago
- Recipients of donated blood, blood products, and organs (once a common means of transmission but now rare in the United States since blood screening became available in 1992)
- People who received a blood product for clotting problems made before 1987
- Hemodialysis patients or persons who spent many years on dialysis for kidney failure
- People who received body piercing or tattoos done with non-sterile instruments
- People with known exposures to the Hepatitis C virus, such as
- Health care workers injured by needlesticks
- Recipients of blood or organs from a donor who tested positive for the Hepatitis C virus
- HIV-infected persons
- Children born to mothers infected with the Hepatitis C virus
Less common risks include:
- Having sexual contact with a person who is infected with the HCV
- Sharing personal care items, such as razors or toothbrushes, that may have come in contact with the blood of an infected person
What is the risk of a pregnant woman passing Hepatitis C to her baby?
Hepatitis C is rarely passed from a pregnant woman to her baby. About 6 of every 100 infants born to mothers with HCV become infected with the virus. However, the risk becomes greater if the mother has both HIV infection and Hepatitis C.
Can a person get Hepatitis C from a mosquito or other insect bite?
Hepatitis C virus has not been shown to be transmitted by mosquitoes or other insects.
Can I donate blood, organs, or semen if I have Hepatitis C?
No, if you ever tested positive for the HCV (or Hepatitis B virus), experts recommend never donating blood, organs, or semen because this can spread the infection to the recipient.
What are the symptoms of acute Hepatitis C?
Approximately 70%–80% of people with acute HCV do not have any symptoms. Some people, however, can have mild to severe symptoms soon after being infected, including:
- Loss of appetite
- Abdominal pain
- Dark urine
- Clay-colored bowel movements
- Joint pain
- Jaundice (yellow color in the skin or eyes)
How soon after exposure to Hepatitis C do symptoms appear?
If symptoms occur, the average time is 6–7 weeks after exposure, but this can range from 2 weeks to 6 months. However, many people infected with the HCV 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 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 do not have any symptoms. However, if a person has been infected for many years, his or her liver may be damaged. In many cases, there are no symptoms of the disease until liver problems have developed. In persons without symptoms, HCV is often detected during routine blood tests to measure liver function and liver enzyme (protein produced by the liver) level.
How serious is chronic Hepatitis C?
Chronic HCV is a serious disease that can result in long-term health problems, including liver damage, liver failure, liver cancer, or even death. It is the leading cause of cirrhosis and liver cancer and the most common reason for liver transplantation in the United States. Approximately 19,000 people die every year from Hepatitis C related liver disease.
What are the long-term effects of Hepatitis C?
Of every 100 people infected with the Hepatitis C virus, about
- 75–85 people will develop chronic Hepatitis C virus infection; of those,
- 60–70 people will go on to develop chronic liver disease
- 5–20 people will go on to develop cirrhosis over a period of 20–30 years
- 1–5 people will die from cirrhosis or liver cancer
Can a person have normal liver enzyme (e.g., ALT) results 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 infected persons have liver enzyme levels that are normal for over a year even though they have chronic liver disease. If the liver enzyme level is normal, persons should have their enzyme level re-checked several times over a 6–12 month period. If the liver enzyme level remains normal, the doctor may check it less frequently, such as once a year.
Who should get tested for Hepatitis C?
Talk to your doctor about being tested for Hepatitis C if any of the following are true:
- You were born from 1945 through 1965
- You are a current or former injection drug user, even if you injected only one time or many years ago.
- You were treated for a blood clotting problem before 1987.
- You received a blood transfusion or organ transplant before July 1992.
- You are on long-term hemodialysis treatment.
- You have abnormal liver tests or liver disease.
- You work in health care or public safety and were exposed to blood through a needlestick or other sharp object injury.
- You are infected with HIV.
If you are pregnant, should you be tested for Hepatitis C?
No, getting tested for Hepatitis C is not part of routine prenatal care. However, if a pregnant woman has risk factors for HCV virus infection, she should speak with her doctor about getting tested.
What blood tests are used to test for Hepatitis C?
Several different blood tests are used to test for HCV. A doctor may order just one or a combination of these tests. Typically, a person will first get a screening test that will show whether he or she has developed antibodies to the Hepatitis C virus. (An antibody is a substance found in the blood that the body produces in response to a virus.) Having a positive antibody test means that a person was exposed to the virus at some time in his or her life. If the antibody test is positive, a doctor will most likely order a second test to confirm whether the virus is still present in the person’s bloodstream.
Can acute Hepatitis C be treated?
Yes, acute hepatitis C can be treated. Acute infection can clear on its own without treatment in about 25% of people. If acute HCV is diagnosed, treatment does reduce the risk that acute hepatitis C will become a chronic infection. Acute HCV is treated with the same medications used to treat chronic Hepatitis C. However, the optimal treatment and when it should be started remains uncertain.
Can chronic Hepatitis C be treated?
Yes. There are several medications available to treat chronic HCV, including new treatments that appear to be more effective and have fewer side effects than previous options. The Food and Drug Administration (FDA) maintains a complete list of approved treatments for Hepatitis C.
Is it possible to get over Hepatitis C?
Yes, approximately 15%–25% of people who get HCV will clear the virus from their bodies without treatment and will not develop chronic infection. Experts do not fully understand why this happens for some people.
What can a person with chronic Hepatitis C do to take care of his or her liver?
People with chronic HCV should be monitored regularly by an experienced doctor. They should avoid alcohol because it can cause additional liver damage. They also should check with a health professional before taking any prescription pills, supplements, or over-the-counter medications, as these can potentially damage the liver. If liver damage is present, a person should check with his or her doctor about getting vaccinated against Hepatitis A and Hepatitis B.
Is there a vaccine that can prevent Hepatitis C?
Not yet. Vaccines are available only for Hepatitis A and Hepatitis B. Research into the development of a vaccine is under way.
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 HCV. 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
What is HIV and Hepatitis C virus coinfection?
HIV and Hepatitis C virus coinfection refers to being infected with both HIV and the Hepatitis C virus. Coinfection is more common in persons who inject drugs. In fact, 50%–90% of HIV-infected persons who use injection drugs are also infected with the Hepatitis C virus. To learn more about coinfection.
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