What Is Hepatitis C (HCV)?

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Hepatitis C is an infection caused by the hepatitis C virus (HCV) that is mainly transmitted through shared needles. Hepatitis C causes few (if any) symptoms during the initial acute infection and often clears on its own.

For some, however, the infection can progress and become chronic, leading to liver injury, cirrhosis (liver scarring), and even liver cancer. Fortunately, a newer class of drugs called direct-acting antivirals (DAA) can treat all stages of HCV infection, offering cure rates as high as 99%.

This article looks at the causes and symptoms of HCV infection, including how hepatitis C is diagnosed, treated, and prevented.

A yellow sharps disposal container on a counter

asikkk / Getty Images

How Do You Get Hepatitis C?

You can acquire hepatitis C by coming into contact with the blood of someone infected with HCV. In the United States, the vast majority of infections are among injecting drug users.

Among the possible routes of HCV infection in the United States are:

  • Shared needles: Around 67% of injecting drug users who share needles, syringes, or any drug paraphernalia have hepatitis C.
  • Childbirth: Approximately 6% of babies born to a birthing parent with HCV will get hepatitis C.
  • Healthcare exposure: Among healthcare workers, the risk of HCV from a sharps injury is around 1.8%.
  • Sexual exposure: The sexual transmission of HCV is rare but possible, occurring at a rate of around 0.6% and mainly among men who have sex with men (MSM).

Unlikely modes of transmission include tattoos, body piercings, dental procedures, and blood transfusions (due to the routine screening of the U.S. blood supply).

How Hepatitis C Is Not Spread

You cannot get hepatitis C by sharing utensils, breastfeeding, hugging, kissing, holding hands, coughing, or sneezing. It is also not spread through food or water.

Hepatitis C Symptoms

The symptoms of hepatitis C vary by the stage of infection. The acute stage is the period immediately following exposure to the virus. The chronic stage is when the acute infection is not cleared by the immune system but persists for years and even decades beyond.

Acute Symptoms

The majority of people initially infected with HCV are asymptomatic (meaning without symptoms). Only between 20% and 30% develop symptoms, usually within two to 12 weeks of exposure to the virus.

Common symptoms of acute hepatitis C include:

  • Fatigue
  • Fever
  • Nausea or vomiting
  • Loss of appetite
  • Stomach pain
  • Muscle aches
  • Joint aches
  • Dark urine
  • Clay-colored stools
  • Yellowing of the skin and eyes (jaundice)

Chronic Symptoms

Around 45% of people acutely infected with HCV will spontaneously clear the virus within a year of exposure and may never even realize they've had the infection. The remainder will develop a chronic infection in which HCV causes persistent inflammatory damage to the liver over the course of 20 or more years.

While most people have minimal or no symptoms during the early decades of a chronic HCV infection, as many as one in three will experience vague symptoms such as:

  • Chronic fatigue
  • Anxiety
  • Depression
  • Loss of concentration or attention
  • A general feeling of unwellness

These can occur even before there is any significant damage to the liver.


As hepatitis C progresses, around 20% to 25% will develop cirrhosis, in which progressive scarring of the liver makes it function less and less effectively. Most cases develop within 30 years of the acute infection, causing ever-worsening symptoms as the liver damage mounts.

Early signs of cirrhosis include:

  • Fatigue
  • Weakness
  • Itching
  • Loss of appetite
  • Weight loss
  • Nausea
  • Easy bruising
  • Abdominal pain
  • Spider veins (spider angioma)
  • Swelling of legs and feet (edema)

After 10 years, between 10% and 40% of people with HCV-associated cirrhosis will experience decompensation. This is when damage to the liver is so extensive that it is no longer functional.

Signs of decompensated cirrhosis include:

Without treatment, decompensated cirrhosis will lead to liver failure and death.

Symptoms in Females and Males

The symptoms of hepatitis C are the same whether you are female or male. Where they differ is in the rate of infection and the speed at which the disease can progress in those who are chronically infected.

Researchers at the University of Southern California Medical Center highlighted the differences in a 2014 review published in the Journal of Infectious Diseases:

  • People assigned male at birth are more likely to get hepatitis C, accounting for 55% of all infections. This ratio has been relatively steady for decades and is mirrored in other countries.
  • People assigned female at birth are more likely to clear an acute infection than males (37% versus 11%). Estrogen is thought to interfere with HCV replication, accounting for the difference.
  • People assigned male at birth tend to have faster disease progression if chronically infected. Estrogen is thought to offer a protective benefit (evidenced by the fact that the disease can rapidly progress after menopause, when estrogen levels plummet).
  • People assigned female at birth tend to live longer with chronic hepatitis C. They are less likely than males to get decompensated cirrhosis (11% vs. 27%) and liver cancer (1% vs. 4%), and they are also less likely to die if chronically infected (15% vs. 27%).

Complications of Hepatitis C

In addition to cirrhosis, a person with chronic hepatitis C can experience other complications involving the liver and other organ systems, including:

  • Mixed cryoglobulinemia: This is a condition in which abnormal proteins called cryoglobulin block blood vessels, causing fatigue, weakness, joint/muscle pain, and purplish skin lesions.
  • Coronary artery disease (CAD): Chronic HCV infection increases the risk of heart disease by accelerating the buildup of fatty deposits in blood vessels (atherosclerosis).
  • Renal insufficiency: Chronic HCV infection can damage the filtering units of the kidneys, called glomeruli, leading to the progressive loss of renal (kidney) function.
  • Hepatocellular carcinoma (HCC): Between 2% and 6% of people with HCV will develop HCC, the most common form of liver cancer. Of these, between 15% and 20% will die within a year.

What Causes Hepatitis C?

Hepatitis C is caused by the hepatitis C virus (HCV), one of five viruses that cause liver inflammation (hepatitis).

There are seven genetic types of HCV—referred to as HCV genotypes 1 through 7—which vary in their incidence (rate of infection), virulence (aggressiveness), and response to HCV treatment.

HCV Genotypes in the United States

HCV genotype 1 accounts for 60% of global hepatitis C infections and is the predominant type in the United States. HCV genotypes 2 and 3 are less common forms seen in North America.

As a bloodborne infection, injecting drug use is the most common risk factor for contracting HCV. However, there are people who get hepatitis C without any known exposure to blood or a history of drug use.

In the United States, the people most at risk of hepatitis C include:

  • Injecting drug users
  • Infants born to a birthing parent with HCV
  • Healthcare workers who suffer a sharps injury
  • People who had blood transfusions or organ transplants before 1992 (when HCV screening tests were first introduced)
  • People with high-risk sexual behaviors and sexually transmitted infections (STIs), such as human immunodeficiency virus (HIV)

Hepatitis C Testing

Hepatitis C is diagnosed through a combination of blood tests. These tests can tell if you have HCV, which type you have, and whether yours was a recent or long-standing infection.

HCV Antibody Tests

HCV antibody tests detect proteins called antibodies produced by the immune system in response to the virus. Six such tests are licensed by the Food and Drug Administration (FDA), including one rapid test that can return results in around 20 minutes.

These tests return either a reactive/positive result (meaning that HCV antibodies were detected) or a nonreactive/negative result (meaning that HCV antibodies were not detected). Once you have HCV antibodies, you will always have HCV antibodies.

Because it takes time for your body to produce antibodies, you can get a false-negative result (meaning the test wrongly shows you do not have the condition) if you test earlier than eight weeks after the suspected exposure. The average window period for HCV—when antibodies are below the level for detection—is between eight and 11 weeks.


HCV RNA tests detect the genetic material of HCV. The qualitative HCV RNA test can confirm that you have the virus, while the quantitative HCV RNA test counts the actual number of viruses in your blood (called the HCV viral load).

Unlike HCV antibody tests, HCV RNA tests can identify HCV relatively quickly—usually in one to two weeks. This can be useful in detecting acute infections. If the RNA test is positive but the antibody test is negative, it means that the infection was recent.

This is important because almost half of all acute infections clear within a year. In such cases, a healthcare provider may wait to see if clearance occurs before subjecting a person to treatment.

HCV Genotyping

Determining the HCV genotype is essential because it helps direct which drugs are most effective for the type you have. Several tests are licensed for HCV genotyping. These can tell which genotype you have and can also tell if you have a superinfection (meaning that you have more than one genotype).

Hepatitis C Treatment 

Direct-acting antivirals (DAAs) are a newer class of drugs that can achieve cure rates of over 90%, even among people with decompensated cirrhosis. For those without decompensated cirrhosis, cure rates are closer to 99%.

There are five DAAs licensed for use in the United States that are comprised of two or more individual agents:

  • Epclusa (sofosbuvir/velpatasvir)
  • Harvoni (ledipasvir/sofosbuvir)
  • Mavyret (glecaprevir/pibrentasvir)
  • Vosevi (sofosbuvir/velpatasvir/voxilaprevir)
  • Zepatier (elbasvir/grazoprevir)

The drugs are taken once daily by mouth. The duration of treatment can run anywhere from eight to 24 weeks, depending on the genotype, stage of the infection, previous treatment history, and presence or absence of cirrhosis. On occasion, the drug ribavirin may be added to the treatment plan.

Upon completion of treatment, your response will be evaluated with a succession of HCV viral load tests. A "cure" is defined as having an undetectable viral load for 24 weeks, also known as sustained virological response 24 (SVR24).

Affordability of Hepatitis C Drugs

Hepatitis C treatment is expensive, ranging from $25,000 to $95,000 depending on the drug and duration of treatment.

You can significantly reduce the cost of treatment with:

How to Prevent Hepatitis C

Unlike hepatitis A and hepatitis B, there is no vaccine to prevent hepatitis C. The best way to prevent HCV is by avoiding behaviors that can spread the disease.

Here are nine ways to do so:

  • Avoid sharing needles, syringes, or any equipment used to inject drugs.
  • If you inject drugs, get sterile needles and syringes from a reliable source like a pharmacy or community needle-exchange program.
  • If you must reuse injection equipment, mark all your equipment so you know it's yours.
  • If you must share a syringe, clean it with bleach and sterile water.
  • Talk with a healthcare provider about harm-reduction strategies or substance abuse treatment if you want to quit.
  • Seek HCV treatment if you are pregnant and have hepatitis C.
  • Practice safer sex by reducing your number of sex partners, using condoms, and avoiding "rough sex" that can damage tissues.
  • Know your status and the status of your partner by getting screened for HCV.

CDC Testing Recommendations

The CDC recommends hepatitis C screening at least once in a lifetime for all adults 18 and over. Screening is also advised for all pregnant people during each pregnancy,

Living With Chronic Hepatitis C

Though access to hepatitis C drugs has improved in recent years, it may still take time before you can access treatment. In the meantime, there are steps you can take to stay healthy and prevent any further injury to your liver, including:

  • See a healthcare provider at least twice yearly to monitor your condition.
  • Get vaccinated against hepatitis A and B, which can also damage your liver.
  • Do not drink alcohol. If you can't stop, speak with a healthcare provider about alcohol treatment.
  • Tell your healthcare provider about all medications and supplements you take, some of which may be hepatotoxic (toxic to your liver).
  • Eat a healthy diet. Avoid fatty meats, fried foods, processed foods, refined grains, and sugary foods that contribute to fatty liver disease.
  • Get at least 30 minutes of physical activity (such as a brisk walk) at least five days a week.
19 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By James Myhre & Dennis Sifris, MD
Dennis Sifris, MD, is an HIV specialist and Medical Director of LifeSense Disease Management. James Myhre is an American journalist and HIV educator.