Frequently Asked Questions (FAQs) About Hepatitis C

Last updated: April 2022

The Centers for Disease Control and Prevention (CDC) estimates that over 3 million in the United States are living with chronic hepatitis C. Whether you've been diagnosed with hep C, or know someone who has, here's a guide to the basics of hepatitis C.

How is hepatitis C transmitted?

Hepatitis C is passed through contact with contaminated blood. Currently, injection drug use is the most common form of transmission. Research shows that 1/3 of injection drug users aged 18-30 are HCV infected. Additionally, between 70 and 90% of older and former injection drug users are estimated to have HCV infection. HCV can also be passed from mother to baby during birth, through contaminated blood donations or organ transplants (typically those prior to 1992), and through needle-stick injuries (usually involving healthcare providers).1,2

Who is a risk of infection?

  • Current or former injection drug users
  • People who received clotting factor concentrates made before 1987
  • Chronic hemodialysis patients
  • Healthcare workers after needle-sticks involving HCV infected blood
  • Individuals infected with HIV
  • Children born to mothers with infected HCV
  • Recipients of blood transfusions or organ transplants before July 1992. Prior to 1992, blood transfusion was the leading cause of HCV transmission. Today, because of newer screening programs, the risk is approximately 1 per 2,000,000 units transfused1,2

What are statistics about hep C?

  • Approximately 3 million people in the US have chronic HCV
  • Approximately 15-25% of people who are infected with HCV will clear the virus without treatment. Between 75 and 85% of people will develop chronic HCV
  • Approximately 29,178 cases of hep C occurred in 2013 (after adjusting for asymptomatic infection and underreporting).
  • HCV infection is most prevalent among baby boomers- people born between 1945 and 1965
  • Chronic HCV is the leading cause of liver transplants

Out of every 100 people infected with HCV, approximately:

  • 75–85 will develop chronic HCV
  • 60–70 will develop chronic liver disease
  • 5–20 will develop cirrhosis over a period of 20–30 years
  • 1–5 will die from consequences of HCV such as liver cancer or cirrhosis1,2

What is Acute HCV?

  • The acute phase is the initial phase of HCV.
  • Without treatment, approximately 15-25% will clear the virus on their own. Many will be asymptomatic.
  • Approximately 20-30% of people in the acute stage will experience symptoms.
  • For those who do experience symptoms, symptoms will on average appear 4-12 weeks after infection.1,2

What is Chronic HCV?

  • HCV will become chronic in 75-85% of those infected.
  • Many people with chronic HCV can be asymptomatic.
  • Liver Disease ranging from mild to severe (including cirrhosis) can progress for several decades without symptoms.
  • For many, HCV infection goes undetected until they are screened for blood donation or tested for liver enzymes during routine examinations.1,2

How is hep C diagnosed? What tests can patients expect?

  • HCV Antibody Tests – A simple blood test that can detect HCV antibodies. A positive antibody test means the person has been infected at some point. An HCV RNA or Viral Load Test must be used to detect if the person is currently infected.
  • HCV RNA or Viral Load Test – These are tests to see if there's an active HCV infection and the amount of HCV in the blood. Viral load tests are used before, during, and after HCV. There are three types: HCV RNA PCR, bDNA assay, and TMA.
  • Genotype Test – A genotype test is used to determine the specific type of HCV. Your genotype will impact your treatment options.
  • Liver Biochemical/Function Tests – These are blood tests used to assess how well liver is working. Once diagnosed with HCV, patients should be tested for liver disease and severity.
  • Liver BiopsyLiver biopsy is used to measure the severity of inflammation, amount of scarring, and general health of the liver. There are also less invasive screening techniques available such as the Fibroscan.2

What are the symptoms of hep C?

Acute HCV

During the acute phase, many patients will be asymptomatic. However, if symptoms do occur, they may include:1,2

  • Abdominal pain
  • Dark urine
  • Diarrhea
  • Fatigue
  • Fever
  • Flu-like illness
  • Headaches
  • Indigestion
  • Jaundice
  • Loss of appetite
  • Muscle or joint pain
  • Nausea
  • Night sweats
  • Vomiting

Chronic HCV

Symptoms of chronic HCV include:2

  • Abdominal pain
  • Brain fog
  • Depression
  • Fatigue
  • Fever
  • Headaches
  • Indigestion
  • Loss of appetite
  • Mood swings
  • Muscle or joint pain
  • Nausea

Late Stage HCV with Cirrhosis

Symptoms of cirrhosis caused by late stage HCV include:2

  • Abdominal pain and/or bloating
  • Cognitive dysfunction
  • Depression
  • Dizziness
  • Fatigue
  • Fever
  • Fluid retention
  • Frequent urination
  • Headaches
  • Indigestion
  • Jaundice
  • Lack of concentration
  • Loss of appetite
  • Mood swings
  • Muscle or joint pain
  • Nausea
  • Peripheral vision issues
  • Vomiting

What are hep C genotypes?

If you have been diagnosed with hepatitis C infection, your doctor will test you to determine the genotype of the virus that you have. 'Genotype' means genetic variation in the DNA of the virus.

  • At least 7 distinct genotypes exist, with more than 50 subtypes.
  • Genotype 1 is the most commonly found in the US.
  • Genotypes do not change during infection.
  • Patients should be tested for their genotype, because this could impact recommendations for treatment.1,2

How is hep C treated?

Until recently, HCV was usually treated with peginterferon and ribavirin. Fortunately, there have been (and continue to be) many new developments in treating hepatitis C.

Since 2014, The Food and Drug Administration (FDA) has approved several direct-acting antivirals (DAAs) for the treatment of HCV. DAAs work by targeting specific steps in the viral life cycle. Some DAA medications include Harvoni, Viekira XR, Danklinza, Epclusa, Zepatier, Vosevi, and Mavyret. Epclusa, Mavyret, and Vosevi have been approved for the treatment of all hep C genotypes. While older treatment regimens have cure rates around 50%, DAAs have cure rates between 92 and 100%.

The American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) provides suggested treatment guidelines for hepatitis C treatment by genotype.3 For the most current information regarding approved HCV treatments, visit the FDA's website.

How does hep C affect the liver?

Chronic HCV can lead to liver damage, including the first stage of liver scarring (fibrosis) and extensive scar tissue buildup that replaces liver tissue (cirrhosis). Cirrhosis is usually irreversible, and in the advance stages, a liver transplant is usually required. Hepatocellular carcinoma (HCC) (liver cancer) can develop at the later stages of chronic HCV.2

How can patients manage hep C?

  • Healthcare Team - Your healthcare team, such as a primary care physician and infectious disease specialists (gastroenterologist and/or hepatologist), will help you to treat and manage your hepatitis C.
  • Nutrition – The liver processes and detoxifies everything you drink and eat, so a balanced diet is recommended.
  • Alcohol – Studies have shown a heavy consumption of alcohol can severely accelerate HCV progression. Your healthcare providers may recommend that you avoid alcohol.
  • Medication – Many medications (prescribed or over-the-counter) must be processed by the liver, so it’s best to check with a doctor before taking any medications or supplements.
  • FatigueFatigue and low energy levels are quite common. Managing energy levels can help, as well for planning for naps and periods of relaxing.
  • Stress - Many patients experience increased symptoms during periods of stress. Exercise and stress management techniques (such meditation) can help.
  • Exercise – Moderate exercise is recommended.2

Can hep C be cured?

The goal of treatment is to reach sustained virologic response, or SVR. SVR is the marker of a cure for hepatitis C. "SVR12" refers to an undetectable viral load test 12 weeks after completing treatment. "SVR24" refers to an undetectable viral load test 24 weeks after completing treatment. Approximately 90% of people who undergo treatment will achieve SVR. There is no vaccine for hepatitis C.2,3

Can people become infected with a different strain of HCV after they have cleared the initial infection?

Yes. Prior infection with HCV does not protect against a person from being infected again with HCV.1

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