Overview
Hepatitis C is a viral infection that causes liver swelling, or inflammation. The hepatitis C virus (HCV) spreads through contact with blood that has the virus in it. Chronic hepatitis C infection can lead to serious liver damage, but newer antiviral medicines can often cure the infection. Symptoms may not appear for decades, so the U.S. Preventive Services Task Force recommends that all adults ages 18 to 79 years be screened for hepatitis C. People who have had certain risk factors, such as receiving clotting factors before 1987, having hemodialysis, or being born to a mother with hepatitis C, are at a higher risk of infection. Over time, untreated hepatitis C can cause complications like cirrhosis, liver cancer, and liver failure.
Understanding the disease
Symptoms
The symptoms of hepatitis C include jaundice, fatigue, nausea, fever, and muscle aches during the acute phase. In the chronic phase, symptoms may appear only after the virus damages the liver and can include bleeding easily, bruising easily, fatigue, loss of appetite, yellowing of the skin and eyes, dark-colored urine, itchy skin, fluid buildup in the stomach area, swelling in the legs, weight loss, confusion, drowsiness, slurred speech, spiderlike blood vessels on the skin, and hepatic encephalopathy. It's important to note that not everyone with hepatitis C experiences symptoms, and many people can have the infection for years without knowing it.
Risk Factors
Risk factors for developing hepatitis C include:
- Sharing needles or other equipment for injection drug use
- Having received a blood transfusion or organ transplant before 1992
- Being born to a mother with hepatitis C
- Having a history of hemophilia and receiving clotting factor concentrates before 1987
- Being a healthcare or emergency worker exposed to blood
- Having unprotected sex with someone who has hepatitis C
- Having HIV infection
- Being a man who has sex with other men
- Engaging in high-risk sexual activities while using pre-exposure prophylaxis (PrEP) to prevent HIV
- Being incarcerated However, it's important to note that hepatitis C can also be transmitted through needlestick injuries or other accidental exposure to infected blood, even among healthcare workers who follow proper precautions.
Development
Hepatitis C infection exists in several forms, called genotypes. There are seven genotypes and 67 subtypes worldwide. The most common hepatitis C genotype in the United States is type 1. Chronic hepatitis C follows the same course regardless of the viral genotype, but treatment can vary depending on the genotype. Newer antiviral drugs can treat many genotypes.
Assessment and Diagnosis
Diagnosis
To diagnose hepatitis C, a screening test is typically performed first. If the screening test shows positive for hepatitis C, other blood tests can be conducted. These tests may measure the quantity of the hepatitis C virus in the blood (viral load) and determine the genotype of the virus. In some cases, additional tests for liver damage may be done, such as magnetic resonance elastography (MRE), transient elastography, or liver function tests. A liver biopsy may also be performed to determine the extent of liver damage.
Management and Treatment
Complications
Complications of hepatitis C can include scarring of the liver (cirrhosis), liver cancer, and liver failure. Chronic hepatitis C can lead to these complications over many years, especially if left untreated.
Treatment
The treatments for hepatitis C are newer antiviral medicines, which are often effective in curing chronic hepatitis C infection. These medications target specific parts of the virus, helping to prevent it from multiplying. However, the effectiveness of these treatments can vary depending on the genotype of the virus. In addition to medication, a healthy lifestyle, including maintaining a healthy weight and avoiding risky behaviors, can help manage the condition.
Preparing for medical consultation
To prepare for an appointment for hepatitis C, follow these steps:
- Make a list of your test results, including any previous tests for hepatitis C, liver biopsy, and blood tests for genotype.
- Note down any symptoms you are experiencing, even if they seem unrelated to hepatitis C.
- Maintain a list of all medications, vitamins, and supplements you are taking, including doses.
- Bring a family member or friend to the appointment for added support and to help remember information discussed during the appointment.
- Prepare a list of questions to ask your healthcare provider, such as whether you should be tested for other causes of liver disease, whether you need treatment, and the pros and cons of different treatment options.
- Discuss any pre-appointment restrictions, such as dietary changes, with your healthcare provider at the time of scheduling.
- Gather information about your family's medical history, particularly any liver diseases. Remember to be open and honest with your healthcare provider about your concerns and ask any questions you may have during the appointment.