Hepatitis C, Chronic

Many people with chronic hepatitis C have no symptoms. Some have a feeling of being generally ill (malaise), loss of appetite, fatigue, and vague abdominal discomfort.

Often, the first specific symptoms are those of cirrhosis or complications of cirrhosis. These symptoms can include

• An enlarged spleen

• Small spiderlike blood vessels visible in the skin (called spider angiomas)

• Redness of the palms

• Accumulation of fluid within the abdomen (ascites)

• A tendency to bleed (coagulopathy)

• Bleeding in the digestive tract due to esophageal varices

• Jaundice (yellowing of the skin and whites of the eyes)

• Deterioration of brain function due to malfunction of the liver (hepatic encephalopathy)

Brain function deteriorates because the badly damaged liver cannot remove toxic substances from the blood as it normally does. These substances then build up in the blood and reach the brain. Normally, the liver removes them from the blood, breaks them down, then excretes them as harmless by-products into the bile (the greenish yellow fluid that aids in digestion) or blood (see Functions of the Liver). Treatment of hepatic encephalopathy can prevent the deterioration of brain function from becoming permanent.

Certain people should talk to their doctor about being tested for hepatitis C, whether they have symptoms suggesting hepatitis or not. One routine screening is recommended for all people 18 years old or over, regardless of risk factors.

One screening is also recommended for people under 18 years old with the following characteristics:

• Are currently using or have ever injected illicit drugs, even if only one time

• Have inhaled illicit drugs

• Are men who have sex with men

• Are currently or have ever been treated with long-term hemodialysis

• Have abnormal liver test results or unexplained chronic liver disease

• Work in health care or public safety and were exposed to blood of a person with hepatitis C through a needlestick or other injury by a sharp object

• Have HIV infection or are starting to take an antiretroviral drug before being exposed to HIV

• Have ever been imprisoned

• Are children born to women with hepatitis C

Such testing is important because symptoms may not develop until the infection has extensively damaged the liver, years after people are first infected.

• Blood tests

Doctors may suspect chronic hepatitis C when

• People have typical symptoms.

• Blood tests (done for other reasons) detect abnormally high liver enzymes.

• People have been previously diagnosed with acute hepatitis C.

Testing for chronic hepatitis usually begins with blood tests to determine how well the liver is functioning and whether it is damaged (liver tests). Liver tests involve measuring the levels of liver enzymes and other substances produced by the liver. These tests may help establish or exclude the diagnosis of hepatitis C and determine the severity of liver damage.

If tests suggest hepatitis, doctors do other blood tests to check for hepatitis B and C virus. Both can cause chronic hepatitis. These blood tests can identify parts of specific viruses (antigens), specific antibodies produced by the body to fight the virus, and sometimes genetic material (RNA or DNA) of the virus. If doctors strongly suspect only chronic hepatitis C, they may do blood tests for only that virus.

If chronic hepatitis C is confirmed, doctors also check for HIV infection and hepatitis B because these infections are often spread in the same ways—through contact with bodily fluids, such as blood or semen.

After hepatitis C is diagnosed, tests may be done to determine how badly the liver is damaged and to check for other causes of liver disease. Tests may include

• A liver biopsy (rare)

• Specialized imaging tests, such as ultrasound elastography and magnetic resonance elastography

• Blood tests to measure substances (called markers) that indicate whether and how much fibrosis is present

Ultrasound elastography and magnetic resonance elastography use sound waves, applied to the abdomen, to determine how stiff the liver tissue is.

• Antiviral drugs

Chronic hepatitis C is treated with antiviral drugs called direct-acting antiviral drugs. Usually, several drugs are used together.

Chronic hepatitis C should be treated unless the person has another disorder that does not respond to treatment and that shortens life expectancy.

Treatment varies based on the genotype of hepatitis C virus causing the infection, degree of damage to the liver, and prior treatment for hepatitis C.

Treatment can last from 8 to 24 weeks. Treating hepatitis C can eliminate the virus from the body and thus stop inflammation and prevent scarring, reducing the risk of developing cirrhosis.

If chronic hepatitis C infection has severely damaged the liver, liver transplantation may be done. After liver transplantation, people with hepatitis C are often treated with antiviral drugs, which improve their chance of being cured.

After treatment is completed, doctors do blood tests to determine how much of the virus's genetic material is present. If none is detected 12 weeks after treatment is completed, people are probably cured.

The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

1. Centers for Disease Control and Prevention: Hepatitis C questions and answers for the public: This web site provides an overview of hepatitis C (including definitions, and statistics) and information about transmission, symptoms, testing, treatment, and hepatitis C and employment. Accessed May 19, 2022.