Hepatitis C, Chronic
Acute hepatitis C becomes chronic in about 75% of affected people.
An estimated 2.7 to 3.9 million people in the United States have chronic hepatitis C. Worldwide, 71 million people are estimated to have chronic hepatitis C.
Chronic hepatitis C, if untreated, causes cirrhosis in about 20 to 30% of people. However, cirrhosis may take decades to develop. The risk of liver cancer is increased usually only if cirrhosis is present.
There are different types (genotypes 1 through 6) of hepatitis C virus, which are sometimes treated with different drugs.
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)
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.
People who have the following characteristics should be screened for hepatitis C:
Were born between 1945 and 1965, regardless of country of birth
Are currently using or have ever injected illicit drugs, even if only one time or only in the distant past
Have inhaled illicit drugs
Were treated with injections (given by vein or injected into a muscle) for a blood clotting problem before 1987
Were given a blood transfusion or organ transplant before July 1992
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
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.
Doctors may suspect chronic hepatitis C when
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
If people have chronic hepatitis C, screening for liver cancer is done every 6 months. It may include the following:
Levels of alpha-fetoprotein—a protein normally produced by immature liver cells in fetuses—usually increase when liver cancer is present.
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. New antiviral drugs to treat hepatitis C are being developed, and thus recommended treatments are rapidly changing.
Many direct-acting antiviral drugs are available to treat hepatitis C. These drugs are highly effective and have minimal side effects because they target the virus directly. They include sofosbuvir, daclatasvir, paritaprevir, ritonavir, ombitasvir, dasabuvir, telaprevir, boceprevir, simeprevir, elbasvir, grazoprevir, velpatasvir, glecaprevir, and pibrentasvir (all taken by mouth).
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.
Ribavirin is sometimes added to the treatment regimen to boost the effectiveness of the antiviral drugs. However, ribavirin can cause birth defects. Both men and women who have to take these drugs should use birth control during treatment and for 6 months after treatment ends.
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 and 24 weeks after treatment is completed, depending on the drug regimen used, people are probably cured.