Veterans Affairs banner with U.S. Flag

VA National Clinical Public Health Programs — Hepatitis C

www.hepatitis.va.gov

Send to printer
< Close window

Basics

What is hepatitis?

Hepatitis means inflammation (or swelling) of the liver.

If the inflammation is caused by a virus, it is called viral hepatitis. Different hepatitis viruses have been given different names, such as A, B, and C. A hepatitis virus is one that lives in liver cells.

When the liver is inflamed, it can have a harder time doing some of its jobs. (See Understanding the Liver (http://www.hepatitis.va.gov/basics-09-00) for more on what the liver does.)

What is hepatitis C?

Hepatitis C is a disease that affects the liver. It is caused by a virus called the hepatitis C virus, or HCV for short.

According to published studies, almost 4 million people in the United States have hepatitis C. Veterans using VA facilities have higher rates of hepatitis C than the general population.

What are the symptoms of hepatitis C?

Most people with hepatitis C don't have any symptoms. Some people, however, can have mild symptoms soon after being infected. These symptoms can include the following:

  • jaundice (yellowing of the eyes and skin)
  • fatigue (being tired)
  • muscle aches
  • dark urine
  • abdominal (stomach) pain
  • loss of appetite
  • nausea

Usually, these symptoms go away without any treatment.

How is hepatitis C diagnosed?

Your doctor will take a small sample of your blood and send it to a laboratory. You will find out the results in 1 to 2 weeks. This first screening test, called an antibody test, tells whether your body has developed antibodies to the hepatitis C virus. (Antibodies are particles your body makes to fight off infections.) Having a positive antibody test means that you were exposed to the virus at some time in your life.

If the antibody test is positive, a second test can confirm whether the virus is still in your body.

You can read more about testing and diagnosis in the Getting Tested (http://www.hepatitis.va.gov/test-00-00) section.

How is hepatitis C spread?

Hepatitis C is a bloodborne virus, which means that it is spread primarily by direct contact with the blood of an infected person.

Here are some examples of things that put you at risk for getting hepatitis C:

  • Injecting street drugs, such as heroin or cocaine, even if it's only once. The needles and other drug "works" that are used to prepare or inject the drug may have had someone else's blood that contained HCV on them.
  • Receiving a blood transfusion or organ transplant before 1991 from a donor whose blood contained hepatitis C. (Before 1991, there was no blood test for hepatitis C.)
  • Being on a kidney machine (called kidney dialysis) for a long time. You may have shared supplies or equipment that had someone else's blood on them.
  • Being a health care worker with frequent contact with blood on the job, especially from accidental needlesticks.
  • Having a mother who had hepatitis C when she gave birth to you.
  • Sharing items such as razors, toothbrushes, and other personal health items that might have had blood on them.
  • Getting a tattoo with unsanitary instruments, as they might have someone else's blood on them.
  • Having unprotected sex with multiple partners. Although hepatitis C rarely is spread through sexual contact, it can happen.

How is hepatitis C not spread?

You cannot get hepatitis C by:

  • holding someone's hand
  • hugging or kissing someone with hepatitis C
  • being coughed or sneezed on
  • eating dirty food or drinking dirty water
  • sharing eating utensils or drinking glasses
  • donating blood
  • breast-feeding

How can I protect myself?

Right now, there is no vaccine to prevent hepatitis C. But there are things you can do to protect yourself from infection. The most important thing is to avoid other people's blood or things that might have other people's blood on them.

Here are some suggestions:

  • Do not shoot drugs. If you shoot drugs, stop and ask your doctor about a treatment program. While you wait for enrollment in a treatment program, do not share or reuse needles or other equipment, and get vaccinated against hepatitis A and B.
  • Don't share personal items that might have blood on them. These items include razors, toothbrushes, and personal health supplies.
  • 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, such as washing hands and using disposable gloves.
  • Practice safer sex. Hepatitis C can be spread by sex, though it is rare for this to happen. Talk with your sex partner about hepatitis C and other sexually transmitted diseases. Use a latex barrier, such as a condom (or rubber), every time you have sex. Get vaccinated against hepatitis B.
  • If you are a health care worker, follow standard precautions. Handle needles and other sharps safely. Report every needlestick or other injury on the job to your supervisor. Get vaccinated against hepatitis B.
  • Talk with your doctor about hepatitis C. Your doctor can provide you with more information about how to protect yourself from hepatitis C infection. These suggestions also may help protect you from other diseases, such as HIV (human immunodeficiency virus) and HBV (hepatitis B virus).

Who should get tested?

Talk with your VA doctor about being tested if any of the following are true for you.

If you:

  • Wish to be tested
  • Have ever used a needle to inject drugs, even if just once and it was a long time ago
  • Had a blood transfusion or organ transplant before 1991
  • Are a health care worker who had contact with blood on the job
  • Are or have been on long-term kidney dialysis
  • Were born of a mother who had hepatitis C at the time
  • Had exposure to blood on the skin
  • Have tattoos or body piercings
  • Have ever snorted cocaine
  • Have liver disease
  • Have a history of drinking a lot of alcohol
  • Have had an abnormal liver function test
  • Have had multiple sex partners

It's OK to get tested if you just want to know your status. If you feel uncomfortable telling your VA health care provider about your sexual or drug-use history, just tell someone in the VA that you are concerned and want to get tested.

What are the long-term effects?

More than half of people with hepatitis C will never have any health problems from it. The disease generally progresses slowly, over the course of 10 to 40 years.

Here is a snapshot of the long-term effects of hepatitis C.

Out of 100 people who get hepatitis C:

  • 15 will get rid of the virus without any treatment
  • 85 will develop a chronic infection

Of those 85 who have a chronic infection, only 30 to 40 will ever develop a lot of liver scarring and be at risk for health problems from hepatitis C.

It is not clear who will develop serious liver disease from hepatitis C, but how you take care of yourself and your liver plays an important role in how slowly (or how quickly) hepatitis C progresses.

You can help keep your liver healthy by eating well, drinking lots of water, and avoiding substances that can harm your liver (such as alcohol and illegal drugs).

Is there treatment for hepatitis C?

If you have been diagnosed with hepatitis C, treatments against the virus are available.

Treatments for hepatitis C are aimed at doing 3 things:

  • removing (or clearing) all the hepatitis C virus from your body
  • stopping or slowing down the damage to your liver
  • making you feel better

Right now, several treatments for hepatitis C have been approved by the U.S. Food and Drug Administration, including:

  • short-acting (standard) or long-acting (pegylated) interferon by itself
  • standard or pegylated interferon combined with another drug called ribavirin (combination therapy)

Interferon is a protein that your body makes to fight infections. Interferon used as a treatment increases the amount of interferon in your body. Ribavirin is a medicine that fights certain viruses.

You can read more about treatments for hepatitis C in the Treatment Decisions section. (http://www.hepatitis.va.gov/treat-00-00)

Is there a cure for hepatitis C?

Doctors prefer not to use the word "cure," but if treatment is successful, it is felt that health risks from hepatitis C can be reduced dramatically.

With successful treatment, the virus goes from always being present to never being present in the blood. Treatment also can make people feel better and may prevent future liver problems.

What is hepatitis C and HIV coinfection?

Coinfection means a person has 2 or more infections at the same time. Because you can get both the human immunodeficiency virus (HIV) and hepatitis C in some of the same ways, there are many people who are infected with both HIV and hepatitis C. These illnesses are very different, so it is important that you learn about both of them.

HIV is the virus that causes AIDS. It is spread mainly through the blood and through sexual contact. You can have HIV and feel healthy. Over many years, however, the virus can wear down your body's immune system, making it hard for your body to fight off dangerous infections. Having HIV also can increase your risk of getting certain cancers.

HIV affects your whole immune system, including your body's ability to fight off hepatitis C. As a result, you might develop a worse case of hepatitis C than someone who doesn't have HIV.

You can read more in the section on Hepatitis C and HIV Coinfection (http://www.hepatitis.va.gov/diag-hiv-00) .

Resources

  • Hepatitis C: An Introductory Guide for Patients
    (http://www.hepatitis.va.gov/vahep?page=basics-hcv-booklet)
    A primer on hepatitis C, including information on the liver's functions, laboratory tests, and treatment
  • The ABCs of Hepatitis
    (http://www.hepatitis.va.gov/vahep?page=prtop07-pe-01)
    Two-page guide to the symptoms, treatment, and prevention of hepatitis A, B, and C
  • American Liver Foundation
    (http://www.liverfoundation.org/)
    A national nonprofit organization dedicated to the prevention, treatment, and cure of hepatitis and other liver diseases through research, education, and advocacy. Web site features a database directory of hepatitis clinical trials, lay-oriented facts sheets, and links to additional resources.
  • Centers for Disease Control and Prevention: Viral Hepatitis
    (http://www.cdc.gov/ncidod/diseases/hepatitis/index.htm)
    Information on all types of viral hepatitis from the CDC's National Center for Infectious Diseases. Site features related CDC guidelines and recommendations as well as training materials, slide sets, fact sheets, and key CDC hepatitis documents.
  • NATAP: Hepatitis
    (http://www.natap.org/hepc.htm)
    Recogizing that coinfection with viral hepatitis among people with HIV is a growing problem, the National AIDS Treatment Advocacy Project (NATAP) has developed an extensive amount of information on hepatitis, both in the context of HIV coinfection and as a separate illness. NATAP provides coverage of key conferences, maintains a selection of hepatitis articles, and features an ask-the-expert forum on hepatitis C.

Glossary

Click on an underlined letter to find the terms that start with that letter.

A  B   C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z

A

Acquired Immune Deficiency Syndrome (AIDS): A severe disorder caused by the HIV retrovirus. It effects your immunity by making you more susceptible to infections and to certain rare cancers. It is mostly transmitted by exposure to contaminated blood and semen.

Alanine aminotransferase (ALT): An enzyme released from liver cells. A blood test that reveals ALT levels above normal may indicate liver damage.

Alanine aminotransferase (ALT): levels and aspartate aminotransferase (AST) levels rise during periods of liver damage, when these enzymes leak out of broken cells. The actual numbers are not as important as how much they increase over time. Many patients with hepatitis C have raised ALT and AST levels, and many patients have normal ALT and AST levels. For those with elevations, one goal of treatment is to get the levels back to normal.

Albumin: A group of proteins made in the liver, and which play an important role in ensuring the maintenance of a normal blood volume.

Albumin (Alb): is a protein made by the liver to keep body fluids in balance. Low levels can indicate poor health and nutrition or a failing liver.

Alkaline phosphatase (AlkPhos): is an enzyme made in the liver's bile ducts and also in bone, kidneys, and intestines. High levels can indicate liver or bone disease.

Alpha-fetoprotein (AFP): is a test used to help diagnose liver cancer.

Anemia: is a shortage of red blood cells that can cause fatigue and other symptoms. Anemia may occur in people on interferon treatment.

Antibodies: are proteins produced by the body to fight infections. The presence in the blood of an antibody to hepatitis C means that the virus is present as well.

Antibody: A protein molecule produced by cells of the immune system in response to a foreign body, such as a virus or bacteria. Antibodies circulate in the blood to protect against infection.

Anti-HCV: (antibody to hepatitis C virus) The antibody directed against the hepatitis C virus (HCV). Its presence in the bloodstream often indicates HCV infection. This antibody has not been shown to protect people against hepatitis C.

Ascites: Fluid within the abdomen, often caused by cirrhosis.

Ascites: is fluid buildup in the abdomen due to high blood pressure in the liver.

Aspartate aminotransferase (AST): An enzyme released from liver cells. A blood test that reveals AST levels above normal may indicate liver damage.

Assay: A test or analysis.

B

bDNA (branched DNA) assay: One of the two tests that reveal the presence in the bloodstream of minute quantities of DNA and RNA, such as RNA fragments from hepatitis C virus.

Biochemical response (BR): Refers to patient's response to interferon therapy by normalization of ALT.

Bilirubin: A bile pigment that is also created by the breakdown of heme pigments. Usually collected by the liver cells, its presence in blood or urine is often a sign of liver damage.

Bilirubin (T bili): is produced by the liver when it recycles red blood cells. Normally it is processed for removal from the body, so high bilirubin is usually a bad sign. At very high levels, your skin can actually turn yellow (jaundice).

Blood-borne substances: Those substances that are present in the blood and are carried by it throughout the body. Blood-borne substances, such as viruses, can be passed on to others through blood transfusions, needle sharing, and even sharing a toothbrush if both people have bleeding gums.

Breakthrough response: A "breaking through" of the virus while on therapy. Detection of virus during therapy in those who had initially lost virus during treatment.

C

Carrier: A person in apparent good health, who has been infected with an organism and is capable of infecting and/or causing disease in others. Individuals persistently infected with hepatitis B and C without evidence of liver injury are considered "carriers."

Chronic infection: An infection that persists and that returns after it had seemed to be cured. Disease is defined as evidence of liver injury by abnormality in serum ALT and/or liver histology.

Cirrhosis of the liver: The result of long-standing inflammation and damage in the liver, such as may be caused by a hepatitis C infection or alcohol. It is characterized by excess formation of scar tissue, also called fibrosis, and results in the loss of liver cells and increased resistance of blood flow.

Cirrhosis: is the condition of having extensive scar tissue in the liver (see fibrosis). Permanent damage may have been done as a result of infection or alcohol abuse, and healthy liver cells have been replaced with scar tissue.

Concomitant event: An event, such as a medical condition, that occurs at the same time as another.

D

DNA (deoxyribonucleic acid): A component in cells of all living matter that carries hereditary genetic information. DNA helps determine what an organism will be as it develops to maturity, i.e. a virus, a human.

E

Edema: The puffiness that occurs from abnormal amounts of fluid in the spaces between cells in the body, especially just below the skin.

ELISA (enzyme-linked immunosorbent assay): This is a test that provides information on the presence or amount of antibodies in the bloodstream. This test is sometimes referred to as an "EIA."

Encephalopathy: A variety of brain function abnormalities experienced by some patients with liver disease. These most commonly include confusion, disorientation, and insomnia, and may progress to coma.

Encephalopathy: is damaged brain function caused by cirrhosis. It can lead to coma.

End treatment response (ETR): Refers to response to medications at the end of therapy regime.

Enzymes: Naturally occurring chemical substances in the human body that help a chemical reaction take place. High levels of these enzymes in blood may be a marker of disease.

Enzyme immunoassay (EIA): A test that provides information on the presence or amount of antibodies in the bloodstream. This test is sometimes referred to as an "ELISA."

Epidemiology: Investigation of the causes of, and ways to control, diseases.

F

False-positive: A test result that mistakenly gives a positive reading.

Fibrosis: is the first stage of scar formation in the liver. Scar tissue is an attempt to contain areas of the liver that have been damaged by alcohol, hepatitis C, or other factors.

Flavivirus: A group of related viruses, including the viruses that cause yellow fever. Hepatitis C is a hepacivirus related to flavivirus.

G

Genotype: A pattern of genetic information that is unique to a group of organisms or viruses. Doctors may determine the genotype of hepatitis C to help decide the best treatment.

H

Hepatic: Related to the liver.

Hepatitis: Inflammation (swelling) of the liver.

HCV RNA (hepatitis C virus ribonucleic acid): Fragments of the replicating hepatitis C virus (HCV). These can be detected using sophisticated testing to determine the level of hepatitis C virus present in the serum.

Hepatocellular carcinoma (HCC): Cancer of the liver cells that has progressed into a tumor.

Hepatocellular carcinoma (HCC): is liver cancer.

I

Interferons (IFN): are a group of proteins made by the body that have antiviral, antitumor, and immune system activity. They are also produced synthetically for treatment of medical conditions.

Intravenous drug abuse (IVDA): Acquiring an addiction to narcotic-type drugs that require intravenous administration. The intravenous use and abuse of recreational and other illegal drugs is a common route of transmission for hepatitis C infection.

J

Jaundice: A condition characterized by yellowness of the skin and eyes. Jaundice is a symptom of many disorders, including: obstruction of bile passageways by a gallstone; disease of the liver due to viral infection, alcoholism, or poisons; or breakdown of red blood cells.

N

Neutropenia :means a decreased number of a type of white blood cells that fight infections in the body. Interferon treatment can cause neutropenia.

P

Polymerase chain reaction (PCR): is a test used to determine the number of virus particles in the blood.

Portal hypertension: is high blood pressure in and around the liver. It is often caused by cirrhosis, and it can result in variceal bleeding and ascites.

Prothrombin time (PT): is a test that measures how long your blood takes to clot. Prothrombin helps the blood to clot, so time increases if the liver is not making enough of it.

Q

Quasispecies: One or more sub-populations of a virus occurring within a single genotype in an individual.

R

Recombinant DNA: Genetic material that has been altered and recombined through insertion of new DNA sequences using bioengineering. Many drugs are now produced using recombinant DNA methods.

Recreational drugs: Illegal drugs, such as marijuana, cocaine, and heroin that are used by people addicted to the drugs, or, if not addicted, who feel the effects of the drugs outweigh the risk factors associated with them.

Remission: Partial or complete disappearance - or a lessening of the severity - of symptoms of a disease. Remission may happen on its own or occur as a result of a medical treatment.

RIBA (recombinant immunoblot assay): A test that confirms the presence of HCV antibodies in the bloodstream.

Risk factors: Certain behaviors (such as intravenous drug use or transfusions) linked to the development of an infection such as hepatitis.

RNA (ribonucleic acid): Molecules, found in all cells, that translate DNA genetic information into proteins.

S

Serology: A branch of medical testing that focuses on serum, particularly immune factors in serum.

Seronegative: When the suspected substance being searched for, such as the antibody to hepatitis C virus, does not show up in a blood test.

Seropositive: When the suspected substance being searched for, such as the antibody to hepatitis C virus, does show up in a blood test.

Seroprevalence: The frequency of a seropositive substance in a group of people.

STD (sexually transmitted disease): A communicable disease transmitted by sexual intercourse or genital contact.

Sustained response (SR): A response to therapy that continues over a long time period.

Sustained viral response: Means that six months after the end of interferon treatment, the virus is no longer detectable in the blood.

T

Thrombocytopenia: is a low level of platelets in the blood, sometimes caused by interferon treatment.

Transaminase: A term for alanine aminotransferase (ALT) and aminotransferases (AST).

Transmission: Passing an infection or disease from one person to another.

True-positive: A test result that accurately gives a positive reading.

V

Variceal bleeding: is bleeding from enlarged veins in the esophagus (called varices). Varices form as a result of high blood pressure in the liver.

Viral load: is the amount of virus particles in a milliliter of blood.

Viral load: The measurement of the amount of a given virus in the bloodstream.

Viremia: The presence of a given virus in the bloodstream.

Virologic Response (VR): Refers to patients' loss of detectable HCV RNA during or after medication therapy.

W

White blood cell count (WBC), hematocrit (HCT), and platelets (PLT): are all components of the blood. A low WBC count is called leukopenia. A low HCT count is called anemia and represents a lack of red blood cells. A low platelet count is called thrombocytopenia. These abnormalities can develop as complications of liver disease or as side effects of HCV treatments. A complete blood count (CBC) tests all of these types of blood cells.