What are the symptoms of Hepatitis C?

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Acute HCV infection

Hepatitis C (HCV) infection begins with exposure to the virus. This phase is called acute HCV. The word “acute” means short-term. Acute HCV often doesn’t have any symptoms. In several studies, over two-thirds of patients with acute HCV were asymptomatic (did not experience symptoms). 1,2

Acute HCV infection can develop 2 to 26 weeks following exposure to HCV. In people who develop symptoms, the acute illness usually lasts for 2 to 12 weeks. When symptoms do occur with acute HCV, they typically include jaundice (yellow colored skin or eyes), abdominal pain, and flu-like symptoms, such as fatigue, muscle aches, and nausea. These symptoms will usually disappear within a few weeks. 1

Chronic HCV infection

Acute HCV becomes a chronic disease about 80% of the time. The word “chronic” means long-term or prolonged. Chronic HCV infection is when the virus is detectable for 6 or more months after the initial infection.3,4

Chronic HCV infection can also affect a person without causing obvious symptoms, even if there is damage to the liver. Symptoms may worsen if HCV causes significant liver damage, although this usually takes many years and even decades. The symptoms of chronic HCV include 1,3:

  • Fatigue (feeling tired)
  • Joint pain
  • Muscle aches
  • Fever (low-grade)
  • Decreased appetite
  • Nausea and vomiting
  • Weight loss
  • Abdominal pain, particularly in the upper right quadrant
  • Itching
  • Dark urine (tea-colored)
  • Gray-colored bowel movements
  • Jaundice (yellow colored skin or eyes)

When symptoms of chronic HCV infection occur, they are often nonspecific and difficult to connect to liver disease. Patients may be diagnosed with another illness such as depression. This is why chronic HCV infection is typically discovered only when a doctor is doing routine blood work, such as investigating an elevation in liver enzymes called transaminases (alanine transaminase [ALT] and aspartate transaminase [AST]) that indicate damage to the liver. 1

The normal range for ALT and AST is 8-40 units per liter (U/L), however, the average range in those with chronic HCV, with or without cirrhosis, can be 1.5 times the upper range of normal (~60 U/L). An ALT or AST tup to 250 U/L indicates mild elevation in liver enzymes. Anything above 250 U/L is considered high. While a standard indicator of cirrhosis is an ALT or AST greater than 2000 U/L, this is not necessarily the case for people with HCV. Patients with decompensated cirrhosis may have normal ALT/AST, while those in the acute stage of HCV may have elevations in the 1000s. It’s important to recognize that liver enzymes do fluctuate, so they do not provide all of the necessary information when assessing inflammation or damage to the liver.

HCV and cirrhosis

Cirrhosis is an advanced form of liver disease that has many causes, not just HCV. Alcoholism, hepatitis B, fatty liver disease and other conditions can cause cirrhosis. It is usually irreversible. In advanced stages, the only treatment for cirrhosis is liver transplant. In the US, HCV infection is the most common cause of chronic liver disease, and the most common reason for liver transplantation. Cirrhosis is characterized by the formation of scar tissue (called fibrosis) which replaces liver tissue. As this process progresses, there is a loss of liver function.1 Studies have found that up to 50% of people with chronic HCV infection eventually develop cirrhosis.5,6

In a person with chronic HCV, cirrhosis typically develops gradually. About 20% to 30% of people with chronic HCV infection will develop cirrhosis over a 20- to 30-year period. The most common complication of cirrhosis is called ascites, the retention of fluid in the abdominal cavity. This complication is associated with increased risk for infection and contributes to poor quality of life. 1

Compensated and decompensated cirrhosis

Cirrhosis, has two phases, compensated and decompensated. Compensated cirrhosis means that the liver is still functioning relatively well. In fact, a person with compensated cirrhosis may be asymptomatic. The early symptoms of cirrhosis include:

  • Fatigue
  • Loss of appetite
  • Weight loss
  • Weakness

As cirrhosis advances, the symptoms may include 1:

  • Jaundice (yellowing in the skin or whites of eyes)
  • Itchy skin (pruritus)
  • Muscle cramping
  • Spider veins
  • Swelling (edema) in the lower extremities (feet and legs)
  • Difficulty taking a full breath
  • Feeling full in the belly area
  • Nausea

Decompensated cirrhosis means that the liver is not functioning well. Three serious complications may occur with decompensated cirrhosis1:

  • Portal hypertension. Portal hypertension is increased pressure in the liver’s blood vessels. This pressure can cause varices, which are enlarged veins that can burst. Varices usually form in the upper digestive tract, particularly the esophagus.
  • Ascites. Ascites refers to a swelling of the abdomen, resulting from a retention and build-up of fluid in this area.
  • Hepatic encephalopathy (HE). HE is a brain disorder that develops when the liver is unable to remove toxins from the body. HE may result in impaired concentration, sleep disturbances, confusion, or coma.

Other general symptoms throughout the body can result from loss of liver function due to cirrhosis, reflecting the important role of the liver in maintain a range of basic body functions.1

view references
  1. Chopra S. Clinical manifestations and natural history of chronic hepatitis C virus infection. Uptodate. Di Bisceglie AM, Bloom A, eds. Accessed at: www.uptodate.com. 2014.
  2. Seeff LB. The natural history of chronic hepatitis C virus infection. Clin Liver Dis 1997;1:587-602.
  3. Bonis PAL, Chopra S. Patient information: Hepatitis C (Beyond the Basics). Di Bisceglie AM, Bloom A, eds. Accessed at: www.uptodate.com. 2014.
  4. HCV FAQs for the Public. Centers for Disease Control and Prevention. US Department of Health and Human Services. Available at: http://www.cdc.gov/hepatitis/c/cfaq.htm. Accessed on: 040414.
  5. Tong MJ, el-Farra NS, Reikes AR, Co RL. Clinical outcomes after transfusion-associated hepatitis C. N Engl J Med 1995;332:1463-6.
  6. Yano M, Kumada H, Kage M, et al. The long-term pathological evolution of chronic hepatitis C. Hepatology 1996;23:1334-40.
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