Hepatitis c dormant period

Contents

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Newsweek‘s Sarah Kliff looked into hepatitis C, a virus which can be dormant for decades then emerge to cause liver fibrosis and cirrhosis. It affects between 2.7 million and 3.9 million Americans, two-thirds of them baby boomers.

The virus is transferred through contact with infected blood, typically through intravenous drug use or transplants or blood transfusions that occurred before 1992, the year when officials started screening blood for the disease. Because it can remain dormant for so long, many boomers who contracted the disease during their free and easy youth are just starting to show symptoms.

“Even though Boomers moved on with their lives, they could be living with an infection that happened many years ago,” says John W. Ward, division director for the Center for Disease Control’s Division of Viral Hepatitis. “Now, they’re aging into a period of their lives when Hepatitis C could become manifest through physical symptoms.” One study published last May estimates that, in the next 20 years, total medical costs for Hepatitis C patients will nearly triple, from $30 to $85 billion.

Many don’t even know they have the disease, and Kliff writes that general public awareness is lagging.

Despite affecting 1 percent of the population, hepatitis C remains a disease generally misunderstood by the general public with little in financial commitments from the federal government. The CDC’s National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention had a budget of almost $1 billion for 2008. Only 2 percent of that was allocated to hepatitis B and hepatitis C despite both viruses being five times more prevalent.

Because of the stigma associated with a virus often linked to drug use that causes symptoms (chronic liver disease) often associated with alcohol abuse, officials have found it tricky to convince now-affluent and settled boomers to come to terms with their wild past and acknowledge that they may have exposed themselves to the virus. To get past those barriers, officials have even considered comprehensive age-based screening requirements, Kliff writes.

The CDC is considering a blanket, age-based screening recommendation. “We’re launching studies to see if it’s feasible and makes sense,” says Ward, the CDC official. “Just like everyone over 50 should have a check for colon cancer, it might fit into an age-based checklist of preventative services.”

Related

From the Institute of Medicine: Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C (PDF)

When to get tested for hepatitis C after exposure

Share on PinterestA HCV test should be performed if a person suspects they have been infected, although testing too early may produce incorrect results.

When a person is exposed to HCV, it takes time for the body to recognize it as a virus and begin developing antibodies to fight the infection.

Antibodies are chemicals released by the body in response to an infection. The body begins to release antibodies after the virus particles called HCV RNA are detectable.

If testing is done too soon, during the window period, an early negative result may occur. As a result, testing may need to be repeated in some people.

Those with an HCV infection will be contagious even if they have yet to develop symptoms. If someone believes that they might have contracted the virus, they should speak to a doctor to determine the need and timing for testing.

The HCV virus is transmitted through contact with the blood of an infected person. It can be spread through:

  • sharing of contaminated drug-injecting equipment, such as needles and syringes
  • sexual contact if there is a risk of contact with blood from an infected individual
  • pregnancy through transmitted from mother to child
  • use and re-use of medical equipment that has not been sterilized
  • needlestick injuries, involving the blood of an infected person
  • receiving contaminated blood from unscreened sources
  • sharing of personal hygiene items, such as razors and toothbrushes, if they involve an infected person’s blood
  • having a tattoo or piercing in an unregulated practice where hygiene is poor

It is important to point out that the HCV virus cannot be spread through breast milk, food, water, hugging, kissing, or sharing food or drinks with a person who has the virus.

Who should be tested for hepatitis C?

Some people are at a higher risk for getting hepatitis C and should be tested for the disease. These people include:

  • those who were born between 1945 and 1965
  • current or former injection drug users, or those who use intranasal drugs
  • those who were treated prior to 1987 for a blood-clotting disorder
  • those who received a blood transfusion or organ transplant before July 1992
  • those who are receiving long-term hemodialysis
  • those with abnormal liver function tests or liver disease
  • those in healthcare or public safety professions who have been exposed to HCV from a needlestick or other injury
  • those with HIV, especially HIV-positive men who have unprotected sex with men
  • infants who were born to mothers with HCV

If a person suspects or is told that they have been exposed to someone with HCV, they should speak to their doctor about testing.

People who have been in prison or have tattoos and piercings may require HCV testing, depending on the circumstances.

Thirty Two Frequently Asked Questions on Hepatitis C

25. What does the term genotype mean?

Genotype refers to the genetic make-up of an organism or a virus. There are at least 6 distinct HCV genotypes identified. Genotype 1 is the most common genotype seen in the United States.

26. Is it necessary to do genotyping when managing a person with chronic hepatitis C?

Yes, as there are 6 known genotypes and more than 50 subtypes of HCV, and genotype information is helpful in defining the epidemiology of hepatitis C. Knowing the genotype or serotype (genotype-specific antibodies) of HCV is helpful in making recommendations and counseling regarding therapy. Based on your genotype, the length of treatment, as well as the combination of medication will be determined. The good new now, is that the current HCV therapies are “pan-genotypic”, meaning they work equally well with all of the genotypes. This is great news.
27. What is the risk for HCV infection from a needle-stick exposure to HCV contaminated blood?

After needle stick or sharps exposure to HCV positive blood , about 2 healthcare workers out of 100 will get infected with HCV.

28. What are the recommendations for follow-up of healthcare workers after exposure to HCV positive blood?

Anti-viral agents (e.g., interferon) or immune globulin should not be used for postexposure prophylaxis.

  1. For the source, baseline testing for anti-HCV.

  2. For the person exposed to an HCV-positive source, baseline and follow-up testing including baseline testing for anti-HCV and ALT activity; and follow-up testing for anti-HCV (e.g., at 4-6 months) and ALT activity. (If earlier diagnosis of HCV infection is desired, testing for HCV RNA may be performed at 4-6 weeks.)

29. Should HCV-infected healthcare workers be restricted in their work?

No, there are no recommendations to restrict a healthcare worker who is infected with HCV. The risk of transmission from an infected healthcare worker to a patient appears to be very low. As recommended for all healthcare workers, those who are HCV positive should follow strict aseptic technique and standard precautions, including appropriate use of hand washing, protective barriers, and care in the use and disposal of needles and other sharp instruments.

Hepatitis C 101: Why Does Hepatitis C Often Go Undiagnosed?

Hepatitis C (HCV) is the most common blood-borne infection in the United States, at an estimated 3.9 million Americans infected.1-4 Yet, most are unaware they are carrying the virus. When left undiagnosed and untreated, HCV can cause severe damage to the liver, organ failure, and even loss of life. Around 13,000 people in the United States die from hepatitis C and its complications each year, and the disease is the number one reason for liver transplant surgery.

Of the estimated, 3.9 million Americans infected with hepatitis C, only around half of them have been diagnosed. Even more discouraging, fewer than 40 percent of those who have been diagnosed are receiving medical treatment, and only about 6 percent are treated with the most effective drugs for their condition.

So, why is hepatitis C so often undiagnosed and untreated?

Many patients do not show symptoms

People with an HCV infection commonly go without noticeable symptoms for as many as 20 to 30 years. Those who are infected experience no significant symptoms when they first acquire the infection, and then they can remain symptomless for years, even while the infection is causing damage to their liver and other organs.

They feel perfectly healthy until the disease is rather advanced and has already caused severe inflammation and scarring of the liver.

People then learn they are infected via one of three ways: they have a routine exam with their family practitioner, and their blood tests show elevated enzymes in their liver; they try to donate blood and are notified that they cannot donate, because they have hepatitis C in their blood test, or they eventually develop noticeable symptoms and seek care.

Even when tested, in more than half of all infected people, elevated enzymes or an abnormality in the liver only appears once serious damage has occurred.

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Historically, many people were not tested

Previous testing recommendations only encouraged testing for those who were thought to be at risk. Those who were screened for hepatitis C included: anyone who had ever injected illegal drugs; people who had received an organ transplant or a blood transfusion before 1992, anyone who was given clotting factor concentrates made before 1987, children who were born to infected mothers, patients who were part of a long-term kidney dialysis program, people who were diagnosed with HIV, anyone with symptoms or who had and abnormal liver enzyme test, people who received an organ transplant from a donor who was later diagnosed with hepatitis C, and those who worked in the medical field and may have been exposed to the virus.

Although seemingly expansive, that criteria missed a large number of infected individuals, and they remain undiagnosed.

Many people who are at risk are reluctant to identify their risk factors. Others are entirely unaware that they have an infection, because they don’t have symptoms, and they don’t know they are at risk. This is especially true with those who were exposed as infants or as children.

“Should I be tested?”

As a result of so many people undiagnosed and untreated for hepatitis C, in 2013, the Centers for Disease Control and Prevention (CDC) issued the recommendation that all Americans born between 1945 and 1965 – baby boomers – get tested.

Others who should consider asking their physician if they should get tested are those who fall into high-risk categories including: anyone with an abnormal liver test or an unexplained liver disease, people who received a blood transfusion before 1992, past or present injection drug users, people who have received kidney dialysis, anyone who has had multiple sex partners, people who have had a tattoo or body piercing, veterans (due to poor inoculation procedures), people with a history of heavy alcohol use, medical workers who handle blood, anyone who has received a clotting agent before 1987, and people who have tested positive for HIV.

Testing is simple and done through a blood test that looks for hepatitis C antibodies. If someone tests positive for hepatitis C antibodies, typically, a follow-up test is done to look for the hepatitis C virus in the blood stream, called a viral load test (an RNA or PCR test).

The benefits of early testing

In about 20 percent of cases, the virus disappears on its own within six months of the initial infection, but the remaining 80 percent develop into a chronic infection that can slowly destroy the liver. Since the hepatitis C virus usually doesn’t clear on its own, testing is the only way to ensure that those who are infected do not develop chronic hepatitis C.

Though there can be complications from a chronic infection, such as scarring and impairment of the liver, treatment can effectively slow the disease’s progression or even eradicate the virus altogether. Some of the newest antiviral drugs are effective in clearing the virus in those who previously had an unsuccessful treatment. These newer antivirals are causing fewer side effects, and they are taking a shorter time to put the virus into remission.

Typically, the younger someone is when they acquire an HCV infection, the longer (sometimes 25 years or more) it will take their body to develop severe symptoms, such as cirrhosis. However, someone who is infected at an older age, for example, someone who acquires the infection at age 50, may develop cirrhosis in half the time.

The likelihood of damage to the liver and other organs as a result of a hepatitis C infection decreases dramatically if it is diagnosed and treated early. Even in those who are tested and diagnosed long after they were initially infected, effective treatment reduces the chance of one’s cirrhosis developing into liver cancer.

Whether newly infected or advanced, testing, diagnosis, and treatment can improve the health of those living with hepatitis C.

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Department of Health

Last Reviewed: October 2008

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What is hepatitis C?

Hepatitis C is a liver disease caused by the hepatitis C virus (HCV), which is found in the blood of persons who have this disease. HCV is spread by contact with the blood of an infected person.

Who gets hepatitis C?

Persons at highest risk for HCV infection include:

  • persons who ever injected illegal drugs, including those who injected once or a few times many years ago,
  • people who had blood transfusions, blood products or organ donations before June 1992, when sensitive tests for HCV were introduced for blood screening, and
  • persons who received clotting factors made before 1987.

Other persons at risk for hepatitis C include:

  • long-term kidney dialysis patients,
  • health care workers after exposures (i.e., needle stick or splashes to the eye) to the blood of an infected person while on the job,
  • infants born to HCV-infected mothers,
  • people with high-risk sexual behavior, multiple partners and sexually transmitted diseases,
  • people who snort cocaine using shared equipment, and
  • people who have shared toothbrushes, razors and other personal items with a family member who is HCV-infected.

How is the virus spread?

Like hepatitis B virus, hepatitis C virus is spread when blood of an infected person enters the body of a person who is not infected, such as through sharing needles or “works” when shooting drugs or occupational needle stick injury. The risk of sexual transmission has not been thoroughly studied but appears to be low in long-term, monogamous relationships. There is no evidence that the hepatitis C virus can be transmitted by casual contact such as hugging or shaking hands, through foods, by sharing eating utensils or drinking glasses, or by coughing or sneezing. Hepatitis C is not spread by breastmilk.

What are the symptoms and consequences of infection?

Approximately 20 percent of persons exposed to the virus develop symptoms which may include jaundice (yellowing of the skin and whites of the eyes), fatigue, dark-colored urine, stomach pain, loss of appetite and nausea. After the initial infection, 15-25 percent will recover and 75-85 percent will become chronically infected (life-long infection). Approximately 70 percent of persons chronically infected may develop liver disease, sometimes decades after initial infection.

How soon do symptoms occur?

Symptoms may occur from two weeks to six months after exposure but usually within six to nine weeks.

When and for how long is a person able to spread hepatitis C?

Persons with acute hepatitis C virus infection are generally contagious from one or more weeks before the onset of symptoms. The contagious period is indefinite in chronically infected persons. All persons who test positive should be considered to be potentially contagious.

What is the treatment for hepatitis C?

Drugs (anti-viral) are licensed for treatment of persons with chronic hepatitis C. Combination drug therapy, using pegylated interferon and ribavirin, can get rid of the virus in up to five out of ten of persons with genotype 1, the most common genotype in the U.S. and eight out of ten persons with genotype 2 or 3. It is important to know that not everyone will need treatment. The decision to treat hepatitis C is complex and is best made by a physician experienced in treating the disease.

Is donated blood tested for this virus?

Since the early 1990s, blood donation centers throughout the U.S. have routinely used a blood donor screening test for hepatitis C. Widespread use of this test has significantly reduced the number of post-transfusion hepatitis C infections.

How can the risk of chronic liver disease be reduced among persons infected with hepatitis C?

People who are infected with hepatitis C should not drink alcohol. They should talk with their doctor before taking any new medications, including over-the-counter and herbal medications. They should also talk with their doctor about getting the hepatitis A and hepatitis B vaccines.

How can the spread of hepatitis C be prevented?

People who have had hepatitis C should remain aware that their blood is potentially infectious.

  • Do not shoot drugs; if you shoot drugs, stop and get into a treatment program; if you can’t stop, never share needles, syringes, water or “works”, and get vaccinated against hepatitis A and B.
  • Do not share personal care items that might have blood on them (razors, toothbrushes).
  • If you are a health care or public safety worker, always follow routine barrier precautions and safely handle needles and other sharps; get vaccinated against hepatitis B.
  • Consider the risks if you are thinking about getting a tattoo or body piercing. You might get infected if the tools have someone else’s blood on them or if the artist or piercer does not follow good health practices.
  • HCV can be spread by sex, but this is rare. If you are having sex with more than one steady sex partner, use latex condoms correctly and every time to prevent the spread of sexually transmitted diseases. You should also get vaccinated against hepatitis B.
  • If you are infected with HCV, do not donate blood, organs or tissue.

Is there a vaccine for hepatitis C?

At present time, a hepatitis C vaccine is not available.

Patients With Resolved Hepatitis C Likely Still Contagious

Patients with chronic hepatitis C that has been resolved through therapy or immune response may still be able to infect others with the virus.

About 170 million people worldwide are infected with hepatitis C virus, which can progress to chronic hepatitis, cirrhosis and even liver cancer. In some individuals, the infection seems to resolve, either spontaneously from the efforts of the immune system, or after treatment with interferon and ribavirin.

Patients who achieve a sustained viral response show no clinical or biochemical evidence of liver disease and standard tests can no longer detect the virus in their blood. However, more sensitive research tests are finding that such patients often still have miniscule amounts of the virus in their bodies. No one knows if these trace remainders are infectious.

Researchers led by Tomasz I. Michalak of Memorial University of Newfoundland, Canada examined this question using a system that allows for propagation of HCV in human T cells in vitro.

They began with nine patients with HCV who had achieved a sustained viral response that persisted for at least two years after treatment. HCV RNA was detectable in their blood only with the more sensitive tests.

The researchers set up twelve cultures of lymphoid cells from healthy donors, and exposed them to plasma or to supernatants of cultured circulating lymphoid cells from the HCV patients. Eleven of the cell cultures became HCV RNA positive. Furthermore, HCV from three of the nine patients was able to establish active HCV replication in the cultures.

“These findings provide in vitro evidence that trace quantities of HCV persisting in the circulation for a long time after therapeutically induced resolution of CHC can remain infectious,” the authors report.

Interestingly, HCV replication in the T cells was prevented after neutralization of the virus, and by treatment with interferon.

This study is the first to investigate the infectivity of HCV traces that remain when the infection is occult. It agrees with previous animal studies of the same question.

“Our present findings reveal that HCV circulating in some individuals with resolved hepatitis C is capable of inducing productive infection in vitro at doses of 20 to 50 copies,” the authors conclude. “This can be interpreted as a strong indication of potential virus infectivity in vivo.”

What is hepatitis?

Online Q&A
Reviewed September 2019

Q: What is hepatitis?

A: Hepatitis is an inflammation of the liver. The condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer. Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause hepatitis.

There are 5 main hepatitis viruses, referred to as types A, B, C, D and E. These 5 types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread. In particular, types B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis and cancer.

Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids. Common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact.

Acute infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.

Q: What are the different hepatitis viruses?

A: Scientists have identified 5 unique hepatitis viruses, identified by the letters A, B, C, D, and E. While all cause liver disease, they vary in important ways.

Hepatitis A virus (HAV) is present in the faeces of infected persons and is most often transmitted through consumption of contaminated water or food. Certain sex practices can also spread HAV. Infections are in many cases mild, with most people making a full recovery and remaining immune from further HAV infections. However, HAV infections can also be severe and life threatening. Most people in areas of the world with poor sanitation have been infected with this virus. Safe and effective vaccines are available to prevent HAV.

Hepatitis B virus (HBV) is transmitted through exposure to infective blood, semen, and other body fluids. HBV can be transmitted from infected mothers to infants at the time of birth or from family member to infant in early childhood. Transmission may also occur through transfusions of HBV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. HBV also poses a risk to healthcare workers who sustain accidental needle stick injuries while caring for infected-HBV patients. Safe and effective vaccines are available to prevent HBV.

Hepatitis C virus (HCV) is mostly transmitted through exposure to infective blood. This may happen through transfusions of HCV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. Sexual transmission is also possible, but is much less common. There is no vaccine for HCV.

Hepatitis D virus (HDV) infections occur only in those who are infected with HBV. The dual infection of HDV and HBV can result in a more serious disease and worse outcome. Hepatitis B vaccines provide protection from HDV infection.

Hepatitis E virus (HEV) is mostly transmitted through consumption of contaminated water or food. HEV is a common cause of hepatitis outbreaks in developing parts of the world and is increasingly recognized as an important cause of disease in developed countries. Safe and effective vaccines to prevent HEV infection have been developed but are not widely available.

Hepatitis C Questions and Answers for the Public

Overview

What is hepatitis?

Hepatitis means inflammation of the liver. When the liver is inflamed or damaged, its function can be affected. Heavy alcohol use, toxins, some medications, and certain medical conditions can all cause hepatitis. However, hepatitis is often caused by a virus. In the United States, the most common hepatitis viruses are hepatitis A virus, hepatitis B virus, and hepatitis C virus.

What is the difference between hepatitis A, hepatitis B, and hepatitis C?

Hepatitis A, hepatitis B, and hepatitis C are liver infections caused by three different viruses. Although each can cause similar symptoms, they are spread in different ways and can affect the liver differently. Hepatitis A is usually a short-term infection. Hepatitis B and hepatitis C can also begin as short-term infections but in some people, the virus remains in the body, and causes chronic (lifelong) infection. There are vaccines to prevent hepatitis A and hepatitis B; however, there is no vaccine for hepatitis C.
The page “What is viral hepatitis?” explains in detail the differences between hepatitis A, hepatitis B, and hepatitis C.

What is hepatitis C?

Hepatitis C is a liver infection caused by the hepatitis C virus. Hepatitis C can range from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis C is often described as “acute,” meaning a new infection or “chronic,” meaning lifelong infection.

  • Acute hepatitis C occurs within the first 6 months after someone is exposed to the hepatitis C virus. Hepatitis C can be a short-term illness, but for most people, acute infection leads to chronic infection.
  • Chronic hepatitis C can be a lifelong infection with the hepatitis C virus if left untreated. Left untreated, chronic hepatitis C can cause serious health problems, including liver damage, cirrhosis (scarring of the liver), liver cancer, and even death.

What is the likelihood that acute hepatitis C will become chronic?

Approximately 75%–85% of people who become infected with hepatitis C virus will develop a chronic infection.

Is it possible to clear the hepatitis C virus?

Yes, approximately 15%–25% of people who are infected with the hepatitis C virus clear it from their bodies without treatment and do not develop chronic infection. Experts do not fully understand why this happens for some people.

Statistics

How common is acute hepatitis C in the United States?

In 2017, a total of 3,216 cases of acute hepatitis C were reported to CDC. Since many people may not have symptoms or don’t know they are infected, their illness is often not diagnosed or reported and therefore can’t be counted. CDC estimates the actual number of acute hepatitis C cases was closer to 44,700 in 2017.

How common is chronic hepatitis C in the United States?

In 2016, there were an estimated 2.4 million people living with hepatitis C in the United States.

Transmission / Exposure

How is hepatitis C spread?

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 prepare or inject drugs. Before 1992, hepatitis C was also commonly spread through blood transfusions and organ transplants. After that, widespread screening of the blood supply in the United States virtually eliminated this source of infection.

People can become infected with the hepatitis C virus during such activities as:

  • Sharing needles, syringes, or other equipment to prepare or 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 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
  • Getting a tattoo or body piercing in an unregulated setting

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.

Can I be re-infected with hepatitis C virus if I have cleared the virus?

Yes. If you have been infected with the hepatitis C virus and cleared the virus, or if you have been successfully treated and cured, you can be re-infected with the hepatitis C virus.

Can hepatitis C virus be spread through sexual contact?

Yes, but the risk of transmission from sexual contact is believed to be low. The risk increases for people who have multiple sex partners, have a sexually transmitted disease, engage in rough sex, or are infected with HIV.

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. Unregulated tattooing and piercing are known to occur in prisons and other informal settings and may put a person at risk of infection.

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.

Who is at risk for hepatitis C?

Some people are at increased risk for having hepatitis C, including:

  • Current or former injection drug users, including those who injected only once many years ago
  • Those born from 1945 through 1965
  • Recipients of clotting factor concentrates made before 1987, when less advanced methods for manufacturing those products were used
  • Recipients of blood transfusions or solid organ transplants prior to July 1992, before better testing of blood donors became available
  • Hemodialysis patients
  • People with known exposures to the hepatitis C virus, such as
    • Health care workers after needle sticks involving blood from someone who is infected with the hepatitis C virus
    • Recipients of blood or organs from a donor who tested positive for the hepatitis C virus
  • People with HIV infection
  • Children born to mothers infected with the hepatitis C virus
  • People who are incarcerated
  • People who use intranasal drugs
  • People who received body piercing or tattoos done with non-sterile instruments

What is the risk of a pregnant woman passing hepatitis C to her baby?

About 6 in 100 infants born to mothers with hepatitis C become infected with the hepatitis C virus. However, the risk becomes greater if the mother has both HIV and hepatitis C.

Can a person get hepatitis C virus from a mosquito or other insect bite?

No, the hepatitis C virus has not been shown to be transmitted by mosquitoes or other insects.

Can I donate blood if I have tested positive for hepatitis C?

The American Red Crossexternal icon does not accept blood donations from anyone with current signs or symptoms of hepatitis, or if you have ever tested positive for hepatitis C.

Can someone with hepatitis C donate organs?

According to the U.S. Department of Health & Human Service’s online information on organ donation and transplantationexternal icon, very few conditions would prevent someone from being an organ, eye, or tissue donor. Even with acute or chronic hepatitis C, you may be able to donate your organs or tissues. The transplant team will determine what organs or tissue can be used based on a clinical evaluation, medical history and other factors.

What are the symptoms of acute hepatitis C?

People with new (acute) hepatitis C virus infection usually do not have symptoms or have mild symptoms. When symptoms do occur, they can include:

  • Fever
  • Fatigue
  • Dark urine
  • Clay-colored bowel movements
  • Abdominal pain
  • Loss of appetite
  • Nausea
  • Vomiting
  • Joint pain
  • Jaundice (yellow color in the skin or eyes)

How soon after exposure to hepatitis C virus do symptoms appear?

In those people who develop symptoms from acute infection, the average time from exposure to symptoms ranges from 2 to 12 weeks. However, most people who are 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 hepatitis C 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 virus infection do not have any symptoms or have general, or common symptoms such as chronic fatigue and depression. Many people eventually develop chronic liver disease, which can range from mild to severe, including cirrhosis (scarring of the liver) and liver cancer. Chronic liver disease in people with hepatitis C usually happens slowly, without any signs or symptoms, over several decades. Chronic hepatitis C virus infection is often not recognized until people are screened for blood donation or from an abnormal blood test found during a routine examination.

How serious is chronic hepatitis C?

Chronic hepatitis C can be a serious disease resulting in long-term health problems, including liver damage, liver failure, liver cancer, or even death. It is a major cause of cirrhosis and liver cancer and the most common reason for liver transplantation in the United States. There were 18,153 deaths related to hepatitis C virus reported to CDC in 2016, but this is believed to be an underestimate.

What are the long-term effects of hepatitis C?

Of every 100 people infected with hepatitis C virus:

  • 75-85 will develop chronic infection
  • 10-20 will develop cirrhosis over 20-30 years

Among 100 people with hepatitis C and cirrhosis, with each passing year:

  • 3-6 will develop liver failure
  • 1-5 will develop liver cancer

Developing cirrhosis is more likely if you are male, age 50 years and older, use alcohol, have nonalcoholic fatty liver disease, hepatitis B virus or HIV coinfection, or take immunosuppressive drugs.

Tests

Who should get tested for hepatitis C?

CDC recommends hepatitis C testing for:

  • Current or former injection drug users, including those who injected only once many years ago
  • Everyone born from 1945 to 1965
  • Anyone who received clotting factor concentrates made before 1987
  • Recipients of blood transfusions or solid organ transplants prior to July 1992
  • Long-term hemodialysis patients
  • People with known exposures to the hepatitis C virus, such as
    • health care workers or public safety workers after needle sticks involving blood from someone infected with hepatitis C virus
    • recipients of blood or organs from a donor who tested positive for the hepatitis C virus
  • People with HIV infection
  • Children born to mothers with hepatitis C

Other experts, including a group that helps set health policies in the United States, called the U.S. Preventive Services Task Force (USPSTF) recommends hepatitis C virus testingexternal icon for additional groups including:

  • People in jails or prisons
  • People who use drugs snorted through the nose (in addition to people who inject drugs),

People who get an unregulated tattoo

If I am pregnant, should I be tested for hepatitis C?

Getting tested for hepatitis C is not part of routine prenatal care. However, if you are a pregnant woman who has risk factors for hepatitis C virus infection, you should speak to your doctor about getting tested.

Should a woman with hepatitis C virus infection avoid breastfeeding?

No. There is no evidence that breastfeeding spreads hepatitis C virus. Precautions may be considered if a mothers with hepatitis C has cracked or bleeding nipples because there is not enough information on the risks of transmission when this happens.

What blood tests are used to test for hepatitis C?

The only way to know if you have hepatitis C is to get tested and you may need more than one type of test. A blood test, called a hepatitis C antibody test, can tell if you have ever been infected with the hepatitis C virus. Antibodies are chemicals released into the bloodstream when someone gets infected. Another test, called a hepatitis C virus RNA test, can tell if you have a current infection with the hepatitis C virus. RNA is the virus’ genetic material.

The only way to know if you have hepatitis C is to get tested and you may need more than one type of test. A blood test, called a hepatitis C antibody test, can tell if you have ever been infected with the hepatitis C virus. Antibodies are chemicals released into the bloodstream when someone gets infected. Another test, called a hepatitis C virus RNA test, can tell if you have a current infection with the hepatitis C virus. RNA is the virus’ genetic material.

How do I interpret the results of hepatitis C anti-body test?

There are two possible antibody test results:

  • Non-reactive, or a negative, means that a person has never had hepatitis C. However, if a person has been recently exposed to the hepatitis C virus, he or she will need to be tested again.
  • Reactive, or a positive, means that hepatitis C antibodies were found in the blood and a person has been infected with the hepatitis C virus at some point in time. A reactive antibody test does not necessarily mean a person has hepatitis C. Once someone has been infected, they will always have antibodies in their blood. This is true if even if they have cleared the hepatitis C virus.

A reactive antibody test requires an additional test, called a hepatitis C virus RNA test (or PCR), to confirm whether the virus is still present in the person’s bloodstream.

How soon after exposure to the hepatitis C virus can the antibody test tell if someone is infected?

For most people exposed to the hepatitis C virus, the HCV antibody blood test will be positive in 4–10 weeks. About 97% of people infected will have a positive HCV antibody test 6 months after exposure.

How soon after exposure to the hepatitis C virus can hepatitis C virus be detected by a hepatitis C virus RNA (PCR) test?

A special kind of blood test called a hepatitis C virus RNA test (or PCR) can tell if a person is infected in 2–3 weeks after exposure.

Can a person have normal liver enzyme (e.g., ALT) level 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 people with hepatitis C have liver enzyme levels that are normal for over a year even though they have chronic liver disease.

What is the treatment for acute hepatitis C?

There is not a recommended treatment for acute hepatitis C. People with acute hepatitis C virus infection should be followed by a doctor and only considered for treatment if their infection remains and becomes a chronic infection.

What is the treatment for chronic hepatitis C?

There are several medications available to treat chronic hepatitis C. Hepatitis C treatments have gotten much better in recent years. Current treatments usually involve just 8-12 weeks of oral therapy (pills) and cure over 90% of people with few side effects. For a complete list of currently approved FDA treatments for hepatitis C, please visit http://www.hepatitisc.uw.edu/page/treatment/drugsexternal icon.

What can a person with chronic hepatitis C do to take care of his or her liver?

First, people with chronic hepatitis C should talk to their doctor about treatments, even if they have been treated for hepatitis C in the past. For people with cirrhosis, there is a continued risk of liver cancer even after hepatitis C virus infection is cured. People with chronic hepatitis C, and people with cirrhosis (even if they have been cured for hepatitis C) should be monitored regularly by a doctor and be vaccinated against hepatitis A and hepatitis B. People with chronic hepatitis C should avoid alcohol because it can cause additional liver damage. They also should check with their doctor before taking any prescription pills, herbs, supplements, or over-the-counter medications, as these can potentially damage the liver.

Vaccination

Is there a vaccine that can prevent hepatitis C?

No. Research into the development of a vaccine for hepatitis C is under way. Vaccines are available for hepatitis A and hepatitis B.

Hepatitis C and Employment

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 virus infection. There is no evidence that people can get hepatitis C from food handlers, teachers, or other service providers without blood-to-blood contact.

Hepatitis C and Co-infection with HIV

Can a person be infected with HIV and the hepatitis C virus?

Yes, a person can be infected with both HIV and hepatitis C virus. This is sometimes called “coinfection.” To learn more about coinfection, read HIV and Viral Hepatitis pdf icon.

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