Hepatitis Hepatitis C Hepatitis C Guide Hepatitis C Guide Symptoms Causes Diagnosis Treatment Coping Prevention Symptoms of Hepatitis C Virus By James Myhre & Dennis Sifris, MD 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. Learn about our editorial process Updated on August 05, 2021 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Latesha Elopre, MD, MSPH Medically reviewed by Latesha Elopre, MD, MSPH LinkedIn Latesha Elopre, MD, is a board-certified internist specializing in HIV and an assistant professor of infectious diseases at the University of Alabama at Birmingham. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Stages of Illness Frequent Symptoms Rare Symptoms Complications When to See the Healthcare Provider Frequently Asked Questions Next in Hepatitis C Guide Hepatitis C Virus: Causes and Risk Factors 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. Illustration by Verywell Stages of Illness 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. Acute Hepatitis: About two to 12 months after the virus invades the body, HCV can cause 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. Presentation is often flu-like, with little evidence of liver injury. About one in four people successfully fight off the virus during this stage. Chronic Hepatitis: The majority of those infected with HCV go on to have chronic hepatitis. 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 symptoms. End Stage Hepatitis: A more complicated form of the disease manifests with liver failure and a number of serious complications, which can include kidney failure and liver cancer. Frequent Symptoms 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 year. In chronic hepatitis, these symptoms are generally more persistent than they are in acute hepatitis. Rare Symptoms 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 sensationsAn uncomfortable "pins and needles" sensationItchy skinRaised, bumpy areas of rashDry eyes accompanied by dry mouthRheumatic 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. Cryoglobulinemia: Cryoglobulins are proteins within the blood that get solidified when exposed to cold temperatures, causing problems with circulation. Complications The chronic stage of hepatitis C can persist for decades. During this time, 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 most 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. 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 cirrhosisDecompensated 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 triggers 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 cirrhosisHepatocellular 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 fatigueJaundiceTarry or bloody stoolsThe build-up of fluid in the abdominal cavity, causing swelling and distentionA distinct "sweet-musty" to "rotten egg" breath odorExtreme bruising or bleedingAbnormally decreased urine outputPersonality changes, confusion, or tremorsIncreased sleepinessMuscle wastingWhite discoloration or “milk spots” on the nailsVomiting of bloodEsophageal 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 fatigueJaundiceThe build-up of fluid in the abdominal cavityAbnormal bruising and bleedingUnintentional, extreme weight lossLoss of appetiteFeeling full after eating a small amountDelirium, confusion, or coarse “jerking” muscle movementsAbdominal 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 fatigueChronic abdominal painAbnormally decreased urine outputInability to urinateUrine breath odorMottled or uneven, patchy skin discolorationMuscle wastingSwelling of the legs and feet, or around the eyesNausea or vomiting, particularly in the morning and after mealsIncreased sleepinessRepetitive twitchiness of the legsShortness of breath or difficulty breathingMental 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. When to See the Healthcare Provider 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 healthcare provider even if you do not have obvious symptoms of the infection. Signs of Exposure You should see your healthcare provider 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 HCVIf you have shared needles with anyoneIf 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 Hepatitis C Healthcare Provider Discussion Guide Get our printable guide for your next healthcare provider's appointment to help you ask the right questions. Download PDF Email the Guide Send to yourself or a loved one. Sign Up This Doctor Discussion Guide has been sent to {{form.email}}. There was an error. Please try again. If you develop symptoms of liver failure or severe infection, you should also see your healthcare provider, as the cause could be HCV or another serious condition that also requires medical attention. Signs and symptoms to look out for include: Persistent feversJaundiceChange in the color of your urineNausea, vomiting or diarrhea that is excessive or lasting for longer than a week Unexplained fatigue lasting longer than a weekSwelling of your abdomen Frequently Asked Questions How long is the hepatitis C incubation period prior to showing symptoms? Some people who contract hepatitis C never show symptoms and it is possible to transmit this disease to someone else without showing symptoms. For people who do show symptoms, they typically appear two to 12 weeks after exposure. Symptoms of liver disease or failure can then show up years later. Can hepatitis C be cured? Yes, the use of antiviral medication, specifically direct-acting antivirals, has been shown to cure more than 95% of hepatitis C cases. Hepatitis C Virus: Causes and Risk Factors Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 27 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. Basit H, Tyagi I, Koirala J. Hepatitis C. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430897/ Kamal S. 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