Patient Education: Hepatitis C Infection

What Is Hepatitis C and How Do People Catch the Infection?

Hepatitis C virus (HCV) is a virus that infects the liver, leading to inflammation and, over time, can cause serious liver damage, like scarring (cirrhosis) or liver cancer. Each year, around 1 million people get infected with HCV.[1]

The virus spreads through exposure to infected blood. The most common way people catch it is by sharing needles or other equipment used to inject drugs. It can also spread through sharing razors or other personal items that may have blood on them. Other ways include the following:

• Blood transfusions prior to initiation of screening using second-generation antibody tests.

• Using infected needles for tattooing, acupuncture, or piercings.

• Accidental injuries with used needles in health care settings.

The virus rarely transmits from mothers to newborns and may spread through sexual activities. However, it does not spread through breast milk, food, water, or casual contact such as hugging, kissing, or sharing food with an infected person.

Can People without Symptoms Be Infected with Hepatitis C?

Many individuals infected with HCV may not exhibit any symptoms. Only about 15% of people infected with the HCV show symptoms. These symptoms can include fatigue, jaundice, abdominal pain, loss of appetite, nausea, vomiting, dark-colored urine, and joint pain.

Approximately 70% of patients with an acute HCV infection develop a chronic infection. Those with chronic infection often experience vague symptoms like fatigue or may remain asymptomatic. Chronic infection can progress to cause liver scarring, leading to cirrhosis in 15 to 30% of cases. Early detection of the infection is crucial as it can prevent progressive liver damage.

Can I Take Any Vaccines to Prevent Hepatitis C?

No, currently there is no vaccine for hepatitis C. The virus changes a lot, which makes it hard to create a vaccine, but researchers are working on it.

Which Tests Should I Undergo to Get Checked for Hepatitis C?

Less than 20% of people living with HCV are aware of their infection. Diagnosing an acute infection can be challenging because antibody formation by the immune system can be delayed. The only reliable method for acute infection diagnosis is polymerase chain reaction (PCR) testing done on a blood sample. For general screening, doctors usually start with an HCV antibody test, and if that is positive, they will follow up with another test to check for the virus itself (HCV ribonucleic acid [RNA]). The framework for testing for chronic infection is outlined in [Fig. 1].[2]

Fig. 1 Testing for hepatitis C infection. (This image is provided courtesy of United States Centers for Disease Control and Prevention.)

If you are diagnosed with HCV, additional tests might be done to check for human immunodeficiency virus (HIV) and hepatitis B since they spread in similar ways.

Doctors may also run other tests to see how much the liver has been affected, such as blood tests like aspartate aminotransferase (AST), alanine aminotransferase (ALT), and platelet count, and imaging tests like FibroScan (vibration-controlled transient elastography).

How Often Should I Get Tested for Hepatitis C?

• Individuals older than 18 years should be tested for HCV at least once.

• All pregnant women should be screened for HCV.

• One-time hepatitis C screening is recommended for individuals with recognized risk factors, such as intravenous drug use, people living with HIV, prior transfusions or organ recipients, health care personnel, and infants born to mothers with HCV.

• People who inject drugs and those receiving maintenance hemodialysis should be tested regularly.

What Should I Do if I Think I Have Been Exposed to Hepatitis C as a Health Care Professional?

If you are accidentally exposed to blood in a health care setting, both you and the patient will be tested for HCV. The initial test checks for HCV antibodies, and if it is positive, a follow-up test will check for the actual virus (HCV RNA).

If the patient tests positive for HCV, you will need another test 3 to 6 weeks after exposure and a final test at 4 to 6 months to ensure you are not infected. It is also important to take precautions to avoid spreading the virus to others during this time.

What Are the Various Treatment Options Available if I Test Positive?

If you test positive for hepatitis C, there are effective treatment options available called direct-acting antivirals (DAAs). These medications are well tolerated and include options like sofosbuvir, sofosbuvir/ledipasvir, and sofosbuvir/velpatasvir.[3] The treatment usually lasts between 8 and 12 weeks, and these medicines can cure over 90% of people with HCV. It is very important to take your medication exactly as prescribed to avoid resistance to the treatment. Your doctor will also check for any interactions with other medications you are taking. DAAs are typically not used during pregnancy. After finishing treatment, a follow-up test will be done to ensure the virus is no longer in your blood.[4] Patients cured of HCV can get reinfected.

Does Hepatitis C Treatment Cure the Infection?

Yes, hepatitis C treatment can cure the infection by achieving a sustained virological response (SVR). SVR means that after finishing the treatment, the virus is no longer detectable in your blood. Curing hepatitis C greatly reduces the risk of serious liver problems like scarring, liver failure, and liver cancer.

What Day-to-Day Changes Help in Managing Hepatitis C Infection?

Getting vaccinated against hepatitis A and hepatitis B can help prevent further infections in patients with HCV. These patients need to maintain a healthy weight and avoid alcohol.[5] Herbal medications and certain prescription drugs that may harm the liver should only be taken after consulting with a physician.

Regular ultrasound examinations every 6 months are recommended to monitor for signs of liver cancer. If liver scarring is present, periodic endoscopy should be performed to check for dilated veins in the esophagus (esophageal varices).

If you have issues with substance use, getting help alongside your hepatitis C treatment can improve your overall care.

Can Hepatitis C Spread to Family Members?

The risk of household transmission of HCV is generally low. However, family members should avoid sharing sharp objects, such as razors, nail clippers, or toothbrushes, with the infected person. HCV transmission from an infected mother to her newborn during pregnancy, although rare, can occur, especially if the viral load is high. Breastfeeding is generally safe and does not increase the risk of HCV transmission unless the mother has cracked or bleeding nipples.

Can a Patient Still Spread Hepatitis C to Others while on Treatment?

Yes, even if you are being treated for hepatitis C, you can still pass the virus to others until it is completely gone from your blood. Treatment helps lower the amount of virus, but it is important to keep taking precautions. For example, do not share personal items that could have blood on them, like razors or toothbrushes, while you are on treatment.

If Infected, How Often Should I See My Health Care Provider?

Patients with HCV should see their health care provider every 3 to 6 months to monitor liver enzyme levels and viral load. More frequent visits may be necessary during antiviral treatment to monitor for side effects and adjust medications as needed. After completing antiviral therapy, follow-up visits at 12 and 24 weeks are required to ensure an SVR. The frequency of visits can be tailored to the patient's individual needs.

My Anti-HCV Test Came Back Positive, although I Have Completed My Treatment Course. Should I Be Worried?

The anti-HCV test looks for antibodies your body makes when it is exposed to the HCV. These antibodies can stay in your blood for life, even after the virus is gone. So, if your anti-HCV test is positive, it does not necessarily mean you still have the virus. The most important test to check for an active infection is the HCV RNA test, which looks for the virus itself. If your HCV RNA test is negative, you do not need to worry, even if your anti-HCV test is positive.

Conflict of Interest

P.B. reports no conflict of interest. S.K. reports research grants from Rebiotix, Inc (A Ferring company), Seres, Finch, Vedanta, and Pfizer; and consulting fees from Takeda, Immuron, Rise, and ProbioTech Inc., outside of the submitted work.

Acknowledgments

None.

Ethical Statement

Not applicable.

Author Contributions

All the authors contributed equally to the article.

Data Availability Statement

There are no data associated with this work.

• References

• 1 Martinello M, Solomon SS, Terrault NA, Dore GJ. Hepatitis C. Lancet 2023; 402 (10407): 1085-1096
• 2 CDC. Clinical Screening and Diagnosis for Hepatitis C. 2023 . Accessed July 7, 2024 at: https://www-cdc-gov.mclibrary.idm.oclc.org/hepatitis-c/hcp/diagnosis-testing/
• 3 Maness DL, Riley E, Studebaker G. Hepatitis C: diagnosis and management. Am Fam Physician 2021; 104 (06) 626-635
• 4 Martinez MA, Franco S. Discovery and development of antiviral therapies for chronic hepatitis C virus infection. Adv Exp Med Biol 2021; 1322: 139-157
• 5 Terrault NA. Care of patients following cure of hepatitis C virus infection. Gastroenterol Hepatol (N Y) 2018; 14 (11) 629-634

Publication History

Received: 08 July 2024

Accepted: 19 August 2024

Article published online:
18 September 2024