Continuing Pharmacy Education
Symptoms
- Fever
- Fatigue
- Loss of appetite
- Nausea
- Vomiting
- Abdominal pain
- Dark urine
- Clay-colored bowel movements
- Joint pain
- Jaundice (yellow color in the skin or eyes)
Michelle Martin, PharmD, FCCP, BCPS, BCACP
Clinical Pharmacist; Clinical Assistant Professor
University of Illinois Hospital; University of Illinois at Chicago College of Pharmacy
Maria A. Sorbera, PharmD, BCACP
Assistant Professor of Pharmacy Practice
Long Island University
Lauren M. Hynicka, PharmD, BCPS
Associate Professor Pharmacotherapy
University of Maryland School of Pharmacy
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What you need to know about…
Hepatitis C Virus (HCV)
What is hepatitis?
“Hepatitis” means inflammation of the liver. Toxins, certain drugs, some diseases, heavy alcohol use, and bacterial and viral infections can all cause hepatitis. Hepatitis is also the name of a family of viral infections that affect the liver; the most common types are Hepatitis A, Hepatitis B, and Hepatitis C.
What is the difference between Hepatitis A, Hepatitis B, and Hepatitis C?
Hepatitis A, Hepatitis B, and Hepatitis C are diseases caused by three different viruses. Although each can cause similar symptoms, they have different modes of transmission and can affect the liver differently. Hepatitis A appears only as an acute or newly occurring infection and does not become chronic. People with Hepatitis A usually improve without treatment. Hepatitis B and Hepatitis C can also begin as acute infections, but in some people, the virus remains in the body, resulting in chronic disease and long-term liver problems. There are vaccines to prevent Hepatitis A and B; however, there is not one for Hepatitis C. If a person has had one type of viral hepatitis in the past, it is still possible to get the other types.
What is Hepatitis C?
Hepatitis C is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness that attacks the liver. It results from infection with the Hepatitis C virus (HCV), which is spread primarily through contact with the blood of an infected person. Hepatitis C can be either “acute” or “chronic.”
Acute Hepatitis C virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis C virus. For most people, acute infection leads to chronic infection.
Chronic Hepatitis C virus infection is a long-term illness that occurs when the Hepatitis C virus remains in a person’s body. Hepatitis C virus infection can last a lifetime and lead to serious liver problems, including cirrhosis (scarring of the liver) or liver cancer.
How common is acute Hepatitis C in the United States?
In 2009, there were an estimated 16,000 acute Hepatitis C virus infections reported in the United States.
How common is chronic Hepatitis C in the United States?
An estimated 3.2 million persons in the United States have chronic Hepatitis C virus infection. Most people do not know they are infected because they don’t look or feel sick.
How likely is it that acute Hepatitis C will become chronic?
Approximately 75%–85% of people who become infected with Hepatitis C virus develop chronic infection.
How is Hepatitis C transmitted?
Hepatitis C is usually spread when blood from a person infected with the Hepatitis C virus enters the body of someone who is not infected. Today, most people become infected with the Hepatitis C virus by sharing needles or other equipment to inject drugs. Before 1992, when widespread screening of the blood supply began in the United States, Hepatitis C was also commonly spread through blood transfusions and organ transplants.
People can become infected with the Hepatitis C virus during such activities as
- Sharing needles, syringes, or other equipment to inject drugs
- Needlestick injuries in health care settings
- Being born to a mother who has Hepatitis C
Less commonly, a person can also get Hepatitis C virus infection through
- Sharing personal care items that may have come in contact with another person’s blood, such as razors or toothbrushes
- Having sexual contact with a person infected with the Hepatitis C virus
Can Hepatitis C be spread through sexual contact?
Yes, but the risk of transmission from sexual contact is believed to be low. The risk increases for those who have multiple sex partners, have a sexually transmitted disease, engage in rough sex, or are infected with HIV. More research is needed to better understand how and when Hepatitis C can be spread through sexual contact.
Can you get Hepatitis C by getting a tattoo or piercing?
A few major research studies have not shown Hepatitis C to be spread through licensed, commercial tattooing facilities. However, transmission of Hepatitis C (and other infectious diseases) is possible when poor infection-control practices are used during tattooing or piercing. Body art is becoming increasingly popular in the United States, and unregulated tattooing and piercing are known to occur in prisons and other informal or unregulated settings. Further research is needed to determine if these types of settings and exposures are responsible for Hepatitis C virus transmission.
Can Hepatitis C be spread within a household?
Yes, but this does not occur very often. If Hepatitis C virus is spread within a household, it is most likely a result of direct, through-the-skin exposure to the blood of an infected household member.
How should blood spills be cleaned from surfaces to make sure that Hepatitis C virus is gone?
Any blood spills — including dried blood, which can still be infectious — should be cleaned using a dilution of one part household bleach to 10 parts water. Gloves should be worn when cleaning up blood spills.
How long does the Hepatitis C virus survive outside the body?
The Hepatitis C virus can survive outside the body at room temperature, on environmental surfaces, for at least 16 hours but no longer than 4 days.
What are ways Hepatitis C is not spread?
Hepatitis C virus is not spread by sharing eating utensils, breastfeeding, hugging, kissing, holding hands, coughing, or sneezing. It is also not spread through food or water.
Who is at risk for Hepatitis C?
Some people are at increased risk for Hepatitis C, including
- Current injection drug users (currently the most common way Hepatitis C virus is spread in the United States)
- Past injection drug users, including those who injected only one time or many years ago
- Recipients of donated blood, blood products, and organs (once a common means of transmission but now rare in the United States since blood screening became available in 1992)
- People who received a blood product for clotting problems made before 1987
- Hemodialysis patients or persons who spent many years on dialysis for kidney failure
- People who received body piercing or tattoos done with non-sterile instruments
- People with known exposures to the Hepatitis C virus, such as
-
- Health care workers injured by needlesticks
- Recipients of blood or organs from a donor who tested positive for the Hepatitis C virus
- HIV-infected persons
- Children born to mothers infected with the Hepatitis C virus
Less common risks include:
- Having sexual contact with a person who is infected with the Hepatitis C virus
- Sharing personal care items, such as razors or toothbrushes, that may have come in contact with the blood of an infected person
What is the risk of a pregnant woman passing Hepatitis C to her baby?
Hepatitis C is rarely passed from a pregnant woman to her baby. About 6 of every 100 infants born to mothers with Hepatitis C become infected with the virus. However, the risk becomes greater if the mother has both HIV infection and Hepatitis C.
Can a person get Hepatitis C from a mosquito or other insect bite?
Hepatitis C virus has not been shown to be transmitted by mosquitoes or other insects.
What are the symptoms of acute Hepatitis C?
Approximately 70%–80% of people with acute Hepatitis C do not have any symptoms. Some people, however, can have mild to severe symptoms soon after being infected as listed on the right.
How soon after exposure to Hepatitis C do symptoms appear?
If symptoms occur, the average time is 6–7 weeks after exposure, but this can range from 2 weeks to 6 months. However, many people infected with the Hepatitis C virus do not develop symptoms.
Can a person spread Hepatitis C without having symptoms?
Yes, even if a person with Hepatitis C has no symptoms, he or she can still spread the virus to others.
Is it possible to have Hepatitis C and not know it?
Yes, many people who are infected with the Hepatitis C virus do not know they are infected because they do not look or feel sick.
What are the symptoms of chronic Hepatitis C?
Most people with chronic Hepatitis C do not have any symptoms. However, if a person has been infected for many years, his or her liver may be damaged. In many cases, there are no symptoms of the disease until liver problems have developed. In persons without symptoms, Hepatitis C is often detected during routine blood tests to measure liver function and liver enzyme (protein produced by the liver) level.
How serious is chronic Hepatitis C?
Chronic Hepatitis C is a serious disease that can result in long-term health problems, including liver damage, liver failure, liver cancer, or even death. It is the leading cause of cirrhosis and liver cancer and the most common reason for liver transplantation in the United States. Approximately 15,000 people die every year from Hepatitis C related liver disease.
What are the long-term effects of Hepatitis C?
Of every 100 people infected with the Hepatitis C virus, about
- 75–85 people will develop chronic Hepatitis C virus infection; of those,
- 60–70 people will go on to develop chronic liver disease
- 5–20 people will go on to develop cirrhosis over a period of 20–30 years
- 1–5 people will die from cirrhosis or liver cancer
Can a person have normal liver enzyme (e.g., ALT) results and still have Hepatitis C?
Yes. It is common for persons with chronic Hepatitis C to have a liver enzyme level that goes up and down, with periodic returns to normal or near normal. Some infected persons have liver enzyme levels that are normal for over a year even though they have chronic liver disease. If the liver enzyme level is normal, persons should have their enzyme level re-checked several times over a 6–12 month period. If the liver enzyme level remains normal, the doctor may check it less frequently, such as once a year.
If you are pregnant, should you be tested for Hepatitis C?
No, getting tested for Hepatitis C is not part of routine prenatal care. However, if a pregnant woman has risk factors for Hepatitis C virus infection, she should speak with her doctor about getting tested.
What blood tests are used to test for Hepatitis C?
Several different blood tests are used to test for Hepatitis C. A doctor may order just one or a combination of these tests. Typically, a person will first get a screening test that will show whether he or she has developed antibodies to the Hepatitis C virus. (An antibody is a substance found in the blood that the body produces in response to a virus.) Having a positive antibody test means that a person was exposed to the virus at some time in his or her life. If the antibody test is positive, a doctor will most likely order a second test to confirm whether the virus is still present in the person’s bloodstream.
Can acute Hepatitis C be treated?
Yes, acute hepatitis C can be treated. Acute infection can clear on its own without treatment in about 25% of people. If acute hepatitis C is diagnosed, treatment does reduce the risk that acute hepatitis C will become a chronic infection. Acute hepatitis C is treated with the same medications used to treat chronic Hepatitis C. However, the optimal treatment and when it should be started remains uncertain.
Can chronic Hepatitis C be treated?
Yes. There are several medications available to treat chronic Hepatitis C, including new treatments that appear to be more effective and have fewer side effects than previous options.
Is it possible to get over Hepatitis C?
Yes, approximately 15%–25% of people who get Hepatitis C will clear the virus from their bodies without treatment and will not develop chronic infection. Experts do not fully understand why this happens for some people.
What can a person with chronic Hepatitis C do to take care of his or her liver?
People with chronic Hepatitis C should be monitored regularly by an experienced doctor. They should avoid alcohol because it can cause additional liver damage. They also should check with a health professional before taking any prescription pills, supplements, or over-the-counter medications, as these can potentially damage the liver. If liver damage is present, a person should check with his or her doctor about getting vaccinated against Hepatitis A and Hepatitis B.
Is there a vaccine that can prevent Hepatitis C?
Not yet. Vaccines are available only for Hepatitis A and Hepatitis B. Research into the development of a vaccine is under way.
Should a person infected with the Hepatitis C virus be restricted from working in certain jobs or settings?
CDC’s recommendations for prevention and control of the Hepatitis C virus infection state that people should not be excluded from work, school, play, child care, or other settings because they have Hepatitis C. There is no evidence that people can get Hepatitis C from food handlers, teachers, or other service providers without blood-to-blood contact.
What is HIV and Hepatitis C virus coinfection?
HIV and Hepatitis C virus coinfection refers to being infected with both HIV and the Hepatitis C virus. Coinfection is more common in persons who inject drugs. In fact, 50%–90% of HIV-infected persons who use injection drugs are also infected with the Hepatitis C virus. To learn more about coinfection, visit http://www.cdc.gov/hiv/resources/factsheets/hepatitis.htm.