What Is the Difference Between Acute and Chronic Hepatitis C?

Hepatitis C virus (HCV) infections can be grouped into 2 main types. These are acute (short-term) HCV and chronic (long-term) infection.

Acute HCV

Acute HCV refers to the first 6 months of the virus. If a person tests positive for HCV within 6 months of being exposed, they have acute HCV. Not everyone will know when they have been exposed. Sometimes, the 6-month time frame is a best guess.1,2

Some people (15% to 50%) with acute HCV will clear the virus on their own. This means the body will fight off the virus without treatment.1

Most people with acute HCV will not have any symptoms. Because of this, only a couple thousand cases are reported each year. However, the true number of people with acute HCV may be 50,000 or more per year.1-3

If a person has symptoms of acute HCV, they usually show up about 7 to 8 weeks after exposure to the virus. Common symptoms include:1,2

  • Yellowing of the skin or eyes (jaundice)
  • Dark urine
  • Light-colored bowel movements
  • Belly pain
  • Fatigue
  • Fever and chills
  • Nausea or loss of appetite
  • Muscle or joint pains
  • Skin itching

These are not all of the possible symptoms of acute HCV. If you are worried about your risk or think you have been exposed, talk with your doctor about testing.

Monitoring and treating acute HCV

During the acute phase, HCV can be treated. However, some doctors and people with HCV may wish to wait to see if the body clears the virus on its own first. If you have acute HCV and are wondering if you should be treated, talk with your doctor about your specific situation.

The same types of treatments are used in both acute and chronic HCV. Regardless of whether you are treated in the acute phase, your doctor may still order regular blood tests during this time.1,2

Even if a person’s body will eventually clear the virus on its own, HCV can still be spread during the acute phase. Take other risk-reducing measures to help prevent transmission, such as not sharing toothbrushes or razors, not sharing injection drug supplies, and using barrier protection (such as condoms) during sex.1,2

Chronic HCV

Chronic HCV lasts more than 6 months. People who do not clear acute HCV on their own will go on to have chronic infection. Without treatment, chronic HCV can last decades, if not the rest of a person’s life. The good news is that in most cases, hepatitis C can be cured.1,4

Many people with chronic HCV will not have symptoms for a long time. Symptoms may first appear once severe damage is done to the liver. Many of the same symptoms of acute HCV are signs of liver trouble and can also occur in chronic HCV.1,4

Complications of chronic HCV

Without treatment, chronic HCV can cause many health problems. Scarring of the liver can occur. Reversible scarring is called fibrosis. Permanent scarring that can lead to liver failure is called cirrhosis. Scarring also increases the risk for liver cancer.1

All of the body’s blood passes through the liver. When the liver is scarred, this blood flow can get backed up. This can cause fluid in the legs or belly (ascites). It can also cause certain blood vessels to become overfilled. These are called varices. These swollen vessels can bleed, especially around the esophagus (the tube that carries food from the mouth to the stomach). This bleeding can be severe and life-threatening.2

The liver also cleans toxins out of the blood. If the liver is damaged due to scarring, toxins can build up. This can cause brain fog, confusion, or even coma. When toxins build up and impact the brain, it is called hepatic encephalopathy.2

Treating chronic HCV

There is a cure for HCV. Direct-acting antiviral (DAA) drugs have very high cure rates (over 90%) and few side effects. These hep C drugs are much better than earlier drugs like interferon. Treating HCV as soon as possible can help prevent many long-term complications. Talk with your doctor about the DAAs that may be right for your situation.1,4

Both people who have cleared the virus on their own and those who have been cured can still get HCV again. Practicing good risk-reduction behaviors in the future can help prevent reinfection later on.

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