Let’s Talk About Hepatitis C Symptoms
Would you recognize the symptoms of this serious virus if you had it? Probably not. Learn the signs and get treated before this illness does permanent damage.
You can live with hepatitis C, a viral infection transmitted through blood, for decades unaware and without symptoms—until you’re met with undeniable proof that something is very wrong. It’s crucial to not to dismiss any early signs and to ask your doctor for testing if you suspect you’ve been exposed to hep C. Some reassuring news: With treatment, hep C is curable.
Our Pro Panel
We tapped some of the nation’s top experts in hepatitis C to bring you the most up-to-date information possible.
Nancy Reau, M.D.
Professor, Department of Internal Medicine, and Section Chief, Hepatology Associate Director of Organ Transplantation
Rush Medical College and Rush University Medical Center
Anurag Maheshwari, M.D.
The Center for Liver and Hepatobiliary Diseases at The Melissa L. Posner Institute for Digestive Health and Liver Disease at Mercy Hospital
Mindie H. Nguyen, M.D.
Professor of Medicine and Director for the Hepatology Fellowship in the Division of Gastroenterology and Hepatology and Liver Transplant Program
Stanford University Medical Center
Actually, the most common symptom for hepatitis C is no symptoms at all. The disease can go undetected in the body for years, sometimes decades, which is why it’s important to talk with your doctor about screening if you are in a high-risk group.
You doctor will measure something called viral genetic material in your blood. To do this, you will be asked to take a blood test about three months after you’ve finished your course of treatment. If the test does not show any viral genetic material, it means you are cured of hep C.
Yes. The color of your poop is one indication: Clay-colored stool happens because a damaged liver cannot transfer bilirubin, a substance that gives poop its brown color, from your blood to your stools. That bilirubin instead goes to your urine, which is why people with hep C may have dark pee.
Not always. In fact, for reasons scientists still don’t completely understand, about 30% of people with the hepatitis C clear the infection through their own immune system without requiring any treatment. This usually happens in the first year of infection.
What Exactly Is Hepatitis C?
Hepatitis C is a viral infection that’s super sly; half of those who have it are unaware they have it. Most people don’t show any symptoms so they can live with it—some for decades—and not feel a thing until major complications crop up.
The virus can cause both acute and chronic illness, ranging in severity from a mild illness that lasts a few weeks, to a serious lifelong condition. It’s estimated that 71 million people around the world have chronic hep C, according to the World Health Organization.
Though it may be silent, hep C can become deadly when it lingers in your system for too long. Too much time inside your body takes a toll and can lead to major issues like cirrhosis (scarring of the liver caused by years of damage), liver disease, and cancer of the liver.
For reasons unknown, not everyone who has hep C needs treatment. In fact, 30% of people with the disease clear the infection through their own immune system, typically within 6 months of infection (called the acute phase), without requiring any treatment. But for the 70% whose condition becomes chronic, treatment is necessary.
While all this may sound scary, hep C isn’t what it used to be—it can be completely cured with a relatively quick course of treatment.
How Do You Get Hepatitis C?
Hep C is transmitted through infected blood that gets into another person’s bloodstream. It can’t be passed through taking a bite of someone’s burger, kissing, or by holding hands. The disease is largely transmitted in the following ways:
Organ transplants that took place before 1992 (when blood wasn’t as thoroughly screened)
Being born to a mother who has hep C or born between 1945 and 1965 before the virus was identified and the blood supply was properly screened for the disease
Hep C can also be spread through sexual intercourse, but the risk is considered to be low.
What Are the Most Common Signs and Symptoms of Hepatitis C?
It sounds strange, but there really are no symptoms of hep C. In fact, about half of people with hep C don't even know they're infected, according to the Mayo Clinic.
Those who do have symptoms may experience minor issues like fatigue and muscle aches, which can be chalked up to any number of reasons, like an intense workout or just life in general. But because these symptoms are so ubiquitous, they’re easy to miss, and you likely wouldn’t associate them with hep C.
What Are Less Common Signs and Symptoms of Hepatitis C?
When hep C becomes a chronic infection, meaning it’s been in the body, untreated for years, it can cause signs of liver disease (a broad term for any number of diseases that prevent this vital organ from functioning properly).
This can lead to cirrhosis, making it difficult for the liver to function properly, liver cancer or even liver failure. The liver performs many crucial functions, including: producing protein; breaking down nutrients from food; storing vitamins, minerals and sugar to prevent nutrient shortages; producing bile and removing bacteria from the blood to prevent infection. This is why the damage wrought by Hep C can be so serious.
Watch out for these signs your liver isn’t working as it should:
Clay-colored poop: When your liver is damaged, it can’t transfer bilirubin—a substance that gives poop its brown hue—from blood to your stools.
Dark-colored urine: That bilirubin instead goes to your pee.
Jaundice skin or eyes: As levels of bilirubin build up, the whites of your eyes and your skin take on a yellow cast.
Itchy skin: Liver damage can cause irritating bile salt to build up under the skin.
Stomach pain or swelling: You may experience pain in the upper part of your abdomen.
Swelling in the legs: When your liver is damaged, you often retain fluid.
Waning appetite/Weight loss: You may find that food just doesn’t taste the same and you’re eating less.
Bleeding and bruising easily: A damaged liver doesn’t produce enough clotting proteins.
Fatigue/Fever: You may develop a fever or feel zonked as your body tries to eliminate the infection.
Confusion and slurred speech: Advanced liver disease may cause toxins to accumulate in your brain, making clear thinking and communication difficult.
Spider-like blood vessels on your skin: These veins often surface when you have a surplus of estrogen in your system, common to liver disease.
If you have any of these symptoms, make an appointment with your doctor, pronto, so they can work to determine the cause of the problem, including a possible hep C infection.
Should You Get Tested for Hepatitis C?
Since you can live with hep C for decades without knowing it—it can take 10 to 40 years for hep C to progress from mild disease to cirrhosis, liver failure or liver cancer—the Centers For Disease Control and Prevention recommends a one-time blood screening test for anyone born between 1945 and 1965. This population is more at risk of having received a tainted blood transfusion.
Hepatitis C can only be diagnosed through a simple blood test called an HCV antibody test. True to its name, it looks for antibodies, proteins released into the bloodstream, that show up in someone infected with the hep C virus. If you have a positive HCV antibody test, you’ll then be given a follow-up HCV RNA test to learn whether you have an active infection.
What Are Treatment Options for Hepatitis C?
While no one wants to get diagnosed with a blood infection, hep C is 98% curable when you take the recommended course of treatment. Unlike the weekly interferon injections of the past, which delivered side effects as harsh as chemotherapy, treatment has come a long way in the past few years.
Thanks to a class of meds called direct-acting antivirals (DAAs), most people with hep C can be completely cured of the disease in just a matter of weeks (8 to 12 weeks in many cases). DAAs are taken in daily tablet form and while some patients experience mild side effects, they can usually be managed with OTC meds.
DAAs target and eliminate proteins found in the hep C virus; the two most common medications prescribed are Mavyret (glecaprevir and pibrentasvir) and Epclusa (sofosbuvir and velpatasvir), both of which include a cocktail of different types of antiviral drugs in one pill.
In rare cases (just 2% of patients), DAAs don’t work to clear the virus. When this happens, doctors will most often prescribe a more aggressive antiviral medication such as Vosevi. Because Vosevi is a potent combination of three antiviral drugs (sofosbuvir, velpatasvir, and voxilaprevir), it has a slightly higher burden of side effects, including:
If you’re put on DAAs, your doctor might also prescribe a longer course of treatment to clear the infection and will know for sure if the virus is gone by measuring how much viral genetic material (aka viral RNA) is in your blood.
This is determined through a blood test administered three months after you’ve finished your course of treatment. If no RNA is visible, you’re deemed cured, known as a sustained virologic response (SVR). A sustained virologic response is a very good thing for two key reasons: It’s associated with lower rates of liver cancer and cirrhosis. Translation: Getting rid of hep C gives people a better shot at a longer life.
What Does the Future Look Like After Hepatitis C Treatment?
Because DAAs are so effective and can completely cure the disease, most of those with hep C go on to live normal, healthy lives. But there is a caveat in all this: DAAs are not vaccines and can’t prevent you from getting the infection again (there is no vaccine available yet to prevent hep C).
If you engage in the same behaviors that led to the infection (such as sharing a razor with someone who’s infected or getting a tattoo from an unsterilized needle), you’ll be at risk for contracting the disease again. Be safe.
Hep C Stats: Centers for Disease Control and Prevention. “Surveillance for Vital Hepatitis-United States, 2016.” cdc.gov/hepatitis/hcv/index.htm
All About Hep C: U.S. National Library of Medicine-NIH (n.d.) medlineplus.gov/ency/article/000284.htm
Hep C Basics: Centers for Disease Control and Prevention. (n.d) “Hep C Questions and Answers for the Public.” cdc.gov/hepatitis/hcv/cfaq.htm
Hep C Signs & Symptoms: Mayo Clinic. (n.d.) Symptoms and Causes. mayoclinic.org/diseases-conditions/hepatitis-c/symptoms-causes/syc-20354278
Hep C Facts: World Health Organization. (n.d.) Hepatitis C Fact Sheets. who.int/news-room/fact-sheets/detail/hepatitis-c
Understanding Hep C: National Institute of Diabetes and Digestive and Kidney Diseases-NIH. (n.d.) Liver Disease. niddk.nih.gov/health-information/liver-disease/viral-hepatitis/hepatitis-c