Symptoms of Hepatitis C Virus

The signs and symptoms of hepatitis C virus infection (HCV) vary based on the stage of infection. The most common symptoms include fatigue, jaundice, (yellow coloring of the skin and eyes), fever, and nausea. In advanced stages of the infection, liver failure may cause bleeding problems or encephalopathy (severe confusion). Sometimes liver cancer may develop, often manifesting as a malnourished appearance.

The impact of HCV in the body changes over time after the initial infection. This is largely due to the proliferation of the virus, which can reproduce inside the body, making numerous copies of itself. The progression also has to do with the cumulative effect of the virus on the liver. 

The stages of HCV infection:

• Incubation period: During this stage, you could have been infected with the virus, but you most likely will not have any symptoms. If you do have symptoms, they may include fever, fatigue, or stomach upset. About one in five people successfully fight off the virus during this stage, do not become sick with HCV infection, and actually become immune to the virus. 
• Acute Hepatitis: About two to 12 months after the virus invades the body, HCV can cause a mild to moderate illness. Symptoms of acute infection are seen in about 15 to 20 percent of people who have been exposed to the virus, often flu-like in presentation with little evidence of liver injury.
• Chronic Hepatitis: Over half of those infected with HCV go on to have chronic hepatitis, especially if the infection is left untreated. Chronic infection occurs when the hepatitis C virus (HCV) does not spontaneously clear and remains in the body. Some people develop symptoms of chronic infection years after being infected with the virus, without ever having had acute hepatitis. 

The symptoms of liver failure include generalized flu-like symptoms, as well as more specific signs of liver involvement because the virus targets the liver. Common symptoms that occur in both the acute and chronic phase of HCV infection generally last longer and are more severe during the chronic stage of the infection.  

The most common symptoms of HCV include symptoms that are not specific to hepatitis and occur with most infections. These symptoms are largely due to the activity of the body's own immune system as it fights the virus. The most common symptoms of acute and chronic HCV include:

• Fatigue
• Fever
• Jaundice
• Nausea and vomiting
• Decreased appetite
• Abdominal pain 
• Diarrhea
• Joint pain
• Muscle Pain

Some of the symptoms of acute and chronic stage HCV are similar to the symptoms of any liver disease.

• Bleeding and Bruising: The liver plays a role in producing proteins that aid in blood clotting, which is part of healing from an injury. Bleeding and bruising can be signs of liver dysfunction, resulting from the viral attack on the liver, as well as the body's inflammatory response to the virus. 
• Dark-colored urine: The build-up of bilirubin, which is produced when the liver is infected or impaired, can cause jaundice, as well as the dark coloring of the urine (choluria), and pale or chalky stools.
• Pale or chalky stools

In acute hepatitis, these symptoms typically resolve on their own, although more severe cases involving jaundice and choluria may take up to a month or more. In chronic hepatitis, these symptoms are generally more persistent than they are in acute hepatitis. 

A number of less common symptoms of HCV infection can occur during the acute or chronic stages.  Many of these symptoms result from liver dysfunction or from the body's inflammatory response to the virus. 

• Weight Loss: This may occur due to a number of effects of HCV infection. Nausea, vomiting, and fatigue can diminish your appetite, causing you to reduce the amount of food you want to eat. And, as the liver becomes impaired, it may not produce several important proteins and fats that help you digest and absorb the food you eat, leading to diarrhea and basically, malnutrition even when you eat. 
• Abnormal tingling or burning sensations
• An uncomfortable "pins and needles" sensation
• Itchy skin
• Raised, bumpy areas of rash
• Dry eyes accompanied by dry mouth
• Rheumatic diseases: Joint swelling and muscle aches and pains can begin before you know that you have been exposed to HCV and may also occur at any stage of the infection. The joint and muscle pains are due to the fact that the immune system is stimulated continuously to fight the virus.
• Vasculitis (inflammation of the blood vessels) rarely occurs and may cause a range of effects, including pain, blood clots, and even strokes or heart attacks, although this is rare. 

The chronic stage of hepatitis C can persist for decades. During this time, the gradual build-up of fats steatosis (chronic build-up of fats) and fibrosis (progressive scarring of tissue) can cause damage to the liver. Both of the conditions often develop silently, with as many as 60 to 80 percent of people experiencing little or no signs of illness.

End-stage liver disease refers to the point where the liver has been severely damaged and is unable to function. Symptoms are usually highly evident at this stage, often affecting multiple organ systems, including the brain, kidney, and upper digestive tract. 

Cirrhosis: Among people with chronic hepatitis C infection, 10 to 15 percent will advance an irreversible condition called cirrhosis, in which the damage caused by fibrosis is so extensive that the blood flow in and out of the liver is altered. Cirrhosis is staged by the degree of impairment and classified as either:

• Compensated cirrhosis
• Decompensated cirrhosis

Compensated cirrhosis means that the liver is functioning relatively well and, as such, may cause minimal symptoms. When present, symptoms can include complications involving the skin, muscles, and joints as the constricted blood supply trigger both an increase in localized blood pressure, known as portal hypertension and a build-up of bile and other toxins. 

Among the possible symptoms of compensated cirrhosis:

• Spider veins, mainly on the trunk and face
• Itchy skin
• Redness on the palms of the hands
• Easy bruising or abnormal bleeding
• The build-up of fluid in the ankles and feet
• Poor concentration and memory
• Loss of appetite
• Weight loss
• Shrinking testicles
• Erectile dysfunction or loss of libido
• Alcohol intolerance

The end stage complications of hepatitis C infection include:

• Decompensated cirrhosis
• Hepatocellular carcinoma (HCC)
• End-stage renal disease (ESRD)

Decompensated cirrhosis is a serious condition in which the progressive scarring of the liver has left it severely damaged and unable to function. Symptoms are often profuse and progressive and can present in a number of ways, including:

• Persistent fatigue
• Jaundice
• Tarry or bloody stools
• The build-up of fluid in the abdominal cavity, causing swelling and distention
• A distinct "sweet-musty" to "rotten egg" breath odor
• Extreme bruising or bleeding
• Abnormally decreased urine output
• Personality changes, confusion, or tremors
• Increased sleepiness
• Muscle wasting
• White discoloration or “milk spots” on the nails
• Vomiting of blood
• Esophageal varices (expanded blood vessels of the esophagus that may bleed)

Hepatocellular carcinoma (HCC) is a type of liver cancer that develops almost exclusively in association with cirrhosis in people with hepatitis C. The symptoms of HCC are similar to those of decompensated cirrhosis and can include:

• Persistent fatigue
• Jaundice

• The build-up of fluid in the abdominal cavity
• Abnormal bruising and bleeding
• Unintentional, extreme weight loss
• Loss of appetite
• Feeling full after eating a small amount
• Delirium, confusion, or coarse “jerking” muscle movements
• Abdominal discomfort, particularly in the upper right quadrant below or just under the ribs

End-stage renal disease (ESRD), which is advanced kidney failure, can both be caused and complicated by hepatitis C infection. The symptoms of ESRD vary and include:

• Persistent fatigue
• Chronic abdominal pain

• Abnormally decreased urine output
• Inability to urinate

• Urine breath odor
• Mottled or uneven, patchy skin discoloration
• Muscle wasting
• Swelling of the legs and feet, or around the eyes
• Nausea or vomiting, particularly in the morning and after meals
• Increased sleepiness
• Repetitive twitchiness of the legs
• Shortness of breath or difficulty breathing
• Mental impairment, confusion

Outcomes of end-stage liver disease are generally poor, with a five-year survival rate of 50 percent in persons with decompensated cirrhosis and 30 percent in those with HCC.

Because the symptoms of HCV may not occur in early stages, and because they are not always terribly alarming, even in the acute and chronic stages, you may need to see a doctor even if you do not have obvious symptoms of the infection.

You should see your doctor if you have been exposed to the virus, either recently or at any time in the past. If you experienced any of the following, you might have been exposed to HCV: 

• If you have had unprotected sex with someone who has or who could have HCV
• If you have shared needles with anyone
• If you have had a cut or a break in your skin from a needle, glass, or any other object that was or could have been contaminated with HCV infected blood

If you develop symptoms of liver failure or severe infection, you should also see your doctor, as the cause could be HCV or another serious condition that also requires medical attention. Signs and symptoms to look out for include:

• Persistent fevers
• Jaundice
• Change in the color of your urine
• Nausea, vomiting or diarrhea that is excessive or lasting for longer than a week 
• Unexplained fatigue lasting longer than a week
• Swelling of your abdomen