Hepatitis C

“Hepatitis” means inflammation of the liver. Toxins, certain drugs, some diseases, heavy alcohol use, and bacterial and viral infections can all cause hepatitis.

Hepatitis C is a contagious liver disease caused by a virus that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness.

• Acute hepatitis C virus infection is a short-term illness that occurs within the first six months after someone is exposed to the hepatitis C virus. Acute infection can, in most cases, lead 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 for longer than six months.

Hepatitis C is spread when blood from an infected person enters another’s body through a break in the skin or mucous membranes (e.g., eyes, sores in the mouth). Today, most people become infected with the hepatitis C virus 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. Hepatitis C is not spread by sharing eating utensils, breastfeeding, hugging, kissing, holding hands, coughing, sneezing, or other casual contact. Hepatitis C virus is not found in urine or feces and is not spread through food or water.

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

• People who inject drugs, 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 (clotting factors) made before 1987
• People who have received long-term hemodialysis
• People who received body piercing or tattoos done with non-sterile instruments In settings outside of a licensed shop such as at someone’s home or in a correctional facility
• People with known exposures to hepatitis C, such as:
  • Healthcare workers injured by needle sticks
  • 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 hepatitis C

Less common risks include:

• Having sexual contact with a person who is infected with the hepatitis C virus. This risk is higher in men who have sex with men or when there are breaks in the skin, such as an open sore.
• Sharing personal care items, such as razors or toothbrushes, that may have come in contact with the blood of an infected person.

A person is contagious during the time that the hepatitis C virus is detectable in their blood. People can infect others for several weeks before their symptoms begin, and until their infection resolves due to spontaneous clearance or treatment. People who have chronic hepatitis C are contagious until they have been successfully treated. A person does not have to have symptoms to spread hepatitis C.

On average, symptoms appear six to seven weeks after exposure, but they can appear any time between two weeks and six months after exposure. Most people with acute hepatitis C do not develop symptoms.

Acute hepatitis C symptoms:

Most people with acute hepatitis C do not have any symptoms. Some people, however, can have mild to severe symptoms soon after being infected, including:

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

Symptoms usually last a few weeks, but some people can be ill for as long as six months.

Chronic hepatitis C symptoms:

Some people with chronic hepatitis C have ongoing symptoms such as fatigue or joint pain, but most individuals remain symptom free for as long as 20 or 30 years. About 15% to 25% of people with chronic hepatitis C develop serious liver conditions, such as cirrhosis (scarring of the liver) or liver cancer. Even as the liver becomes diseased, some people still do not have symptoms, although certain tests for
liver function may show some abnormalities.

Approximately 75 to 85% of people acutely infected will go on to develop a chronic infection. Chronic infections can be treated with a variety of antiviral medications.

Once you recover from hepatitis C, you must get tested by your provider to see if you have cleared the virus. Being free from symptoms does not mean that your immune system fought off the infection.

Though uncommon, it is possible to become re-infected with the hepatitis C virus. If you have recovered from a hepatitis C infection but have ongoing risk factors, it is a good idea to talk to your healthcare provider about yearly testing to check for re-infection. If you get re-infected, you can be treated again.

Chronic hepatitis C is a serious disease that can result in long-term health problems, including liver damage, liver failure, liver cancer, or even death. Approximately 8,000–10,000 people die every year from hepatitis C-related liver disease in the United States.

There are many ways that you can reduce the risk of others getting hepatitis C if you are infected:

• Do not share needles or any other injection supplies, including water, cottons, and cookers. Always wash hands before injecting. The SRHD Syringe Services program provides new syringes and works for free.
• Do not share any straws to snort drugs, or pipes to smoke drugs.
• Cover any open cuts or wounds.
• The risk from sexual transmission is low, but using condoms and barriers may reduce the risk.

Healthcare settings should carefully follow universal precautions to prevent transmission. Do not share any personal hygiene items such as razors, toothbrushes, nail clippers or pierced earrings. Cover personal items and keep them separate from other people you live with.

No. There is no vaccine for hepatitis C. Hepatitis A and hepatitis B vaccination is recommended for anyone with hepatitis C to prevent compounding liver effects.

Hepatitis C treatment has improved dramatically in recent decades. Today, direct acting antiviral drugs are used to treat hepatitis C. Interferon is no longer used. Direct acting antivirals are highly effective, with up to 95% of people treated achieving a cure. These medications are considered to be very safe and have few side effects. Everyone on Washington Apple Health (Medicaid) is eligible for hepatitis C treatment at no cost. Commercial health insurance and Medicare also cover hepatitis C treatment.

Two commonly prescribed direct acting antivirals are Mavyret and Epclusa. Your doctor will determine what medication is best for you. People can be treated for hepatitis C regardless of current or past substance use.