Hepatitis C Questions and Answers for the Public

Index of Questions

Overview and Statistics

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 (long-term) 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, long-term illness. Hepatitis C is often described as “acute,” meaning a new infection, or “chronic,” meaning long-term 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 if left untreated. Chronic hepatitis C can cause serious health problems, including liver damage, cirrhosis (scarring of the liver), liver cancer, and even death.

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, cirrhosis, liver cancer, and even death. It is the most common reason for liver transplantation in the United States. There were 15,713 deaths related to hepatitis C virus reported to CDC in 2018, but this is believed to be an underestimate.

How likely is it that someone with acute hepatitis C will become chronically infected?

More than half of people who become infected with hepatitis C virus will develop a chronic infection.

Is it possible for someone with hepatitis C to get better without treatment

Yes. However, less than half of people who are infected with the hepatitis C virus clear it from their bodies without treatment. Experts do not fully understand why this happens for some people.

How common is acute hepatitis C in the United States?

In 2018, a total of 3,621 cases of acute hepatitis C were reported to CDC. Since many people do not have symptoms, they don’t seek care from a health provider and don’t get diagnosed with this infection. These cases aren’t reported to public health authorities and aren’t counted in yearly totals. CDC believes the actual number of acute hepatitis C cases in 2018 was probably closer to 50,300.

How common is chronic hepatitis C in the United States?

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

Transmission / Exposure

How is hepatitis C spread?

The hepatitis C virus is usually spread when someone comes into contact with blood from an infected person. This can happen through:

►Sharing drug-injection equipment.

Today, most people become infected with hepatitis C by sharing needles, syringes, or any other equipment used to prepare and inject drugs.

►Birth.

Approximately 6% of infants born to infected mothers will get hepatitis C.

►Healthcare exposures.

Although uncommon, people can become infected when health-care professionals do not follow the proper steps needed to prevent the spread of bloodborne infections.

►Sex with an infected person.

While uncommon, hepatitis C can spread during sex, though it has been reported more often among men who have sex with men.

►Unregulated tattoos or body piercings.

Hepatitis C can spread when getting tattoos or body piercings in unlicensed facilities, informal settings, or with
non-sterile instruments.

►Sharing personal items.

People can get infected from sharing glucose monitors, razors, nail clippers, toothbrushes, and other items that may have come into contact with infected blood, even in amounts too small to see.

►Blood transfusions and organ transplants.

Before widespread screening of the blood supply in 1992, hepatitis C was also spread through blood transfusions and organ transplants. Now, the risk of transmission to recipients of blood or blood products is extremely low.

Hepatitis C 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 you get hepatitis C more than once?

Yes. You can be infected again even if you have cleared the virus or were successfully treated and cured. This is why people who currently inject and share needles, syringes, or other drug preparation equipment, along with those who receive maintenance hemodialysis, should be tested for hepatitis C on a regular basis.

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 men who have sex with men and 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?

Research has not shown that hepatitis C is spread within licensed, commercial tattooing facilities. However, transmission of hepatitis C (and other infectious diseases) is possible at facilities that don’t take the necessary measures to control infections during tattooing or piercing. Unregulated tattooing and piercing occurring in prisons and other informal settings 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?

The following people are at increased risk for hepatitis C:

  • People who use injection drugs or did so in the past, even those who injected only once many years ago
  • People with HIV infection
  • People with certain medical conditions, including those who ever received maintenance hemodialysis and those with persistently abnormal alanine aminotransferase (ALT) levels (an enzyme found within liver cells).
  • People who have received transfusions or organ transplants, including those who
    • received clotting factor concentrates produced before 1987
    • received a transfusion of blood or blood components before July 1992
    • received an organ transplant before July 1992
    • were notified that they received blood from a donor who later tested positive for hepatitis C virus infection
  • Health care, emergency medical, and public safety personnel who have been exposed to the blood of someone who has hepatitis C (through needle sticks, sharps, or mucosal exposures)
  • Children born to mothers who have hepatitis C

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

Yes. A person can be “coinfected” with both HIV and the hepatitis C virus. People who are coinfected are more likely to get cirrhosis as a result of their chronic hepatitis C infection. To learn more about coinfection, read HIV and Viral Hepatitis.

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

Of every 100 infants born to mothers with hepatitis C, about six will become infected with the hepatitis C virus. However, the risk is greater if the mother has both HIV and hepatitis C.

Can women with hepatitis C breastfeed their babies?

Yes. There is no evidence that breastfeeding spreads hepatitis C, so infected women can safely breastfeed their babies. However, women with cracked or bleeding nipples should stop nursing temporarily until their nipples have healed. Hepatitis C is spread through contact with blood, and not enough is known about whether this practice is safe.

Can I get hepatitis C 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 who has ever tested positive for hepatitis C or from anyone with current signs or symptoms of hepatitis.

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.

Symptoms

What are the symptoms of acute (new) hepatitis C?

Many people newly infected with the hepatitis C virus don’t have symptoms, don’t look or feel sick, and therefore don’t know they are infected. For people who develop symptoms, they usually happen 2–12 weeks after exposure to the hepatitis C virus and can include yellow skin or eyes, not wanting to eat, upset stomach, throwing up, stomach pain, fever, dark urine, light-colored stool, joint pain, and feeling tired.

What are the symptoms of chronic (long-term) hepatitis C?

Most people with chronic hepatitis C don’t have any symptoms or have only general symptoms like chronic fatigue and depression. Many people eventually develop chronic liver disease, which can range from mild to severe and include 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 doctor’s visit.

Can a person spread hepatitis C without having symptoms?

Yes. If you are infected with the hepatitis C virus, you can spread it to others even if you have no symptoms.

Tests

Who should get tested for hepatitis C?

CDC recommends hepatitis C testing for:

  • Are 18 years of age and older (get tested at least once in your lifetime)
  • Are pregnant (get tested during each pregnancy)
  • Currently inject drugs (get tested regularly)
  • Have ever injected drugs, even if it was just once or many years ago
  • Have HIV
  • Have abnormal liver tests or liver disease
  • Are on hemodialysis
  • Received donated blood or organs before July 1992
  • Received clotting factor concentrates before 1987
  • Have been exposed to blood from a person who has hepatitis C
  • Were born to a mother with hepatitis C

Should anyone be tested for hepatitis C more than once?

Yes. Regular testing is recommended for people who currently inject and share needles, syringes, or other drug preparation equipment and for those currently getting maintenance hemodialysis.

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

Yes, hepatitis C testing is recommended during every pregnancy.

What tests are used to diagnose someone with hepatitis C?

A blood test, called an HCV antibody test, is used to find out if someone has ever been infected with the hepatitis C virus. This test, sometimes called the anti-HCV test, looks for antibodies, which are proteins released into the bloodstream when someone gets infected with the virus that causes hepatitis C. People who have positive HCV antibody tests are given a follow-up HCV RNA test to learn whether they have active infection.

When should I expect to get my test results?

Test results can take anywhere from a few days to a few weeks to come back. Rapid anti-HCV tests are available in some health clinics, and the results of these tests are available in 20–30 minutes.

How are hepatitis C test results interpreted?

Your doctor will help interpret the results from your HCV antibody test and help guide you through next steps. The test can be “non-reactive,” or “negative,” meaning that you are not currently infected with the hepatitis C virus.  The test can also be “reactive,” or “positive,” which means you have been infected with the hepatitis C virus at some point in time. It is important to know that

  • Once you have been infected, you will always have antibodies in your blood. This is true if you have cleared the virus, have been cured, or still have the virus in your blood.
  • A reactive, or positive, antibody test does not necessarily mean that you currently have hepatitis C, so a follow-up test is needed.

What should I do if the HCV antibody test is reactive?

  • If the antibody test is reactive or positive, you need an additional test to see if you currently have hepatitis C. This test is called a nucleic acid test (NAT) for HCV RNA, but it can also be called a PCR test.
  • If the nucleic acid test for HCV RNA (or PCR test) is:
    • Negative – this means you were infected with hepatitis C virus, but the virus is no longer in your body because you were cured or cleared the virus naturally.
    • Positive – this means you currently have the virus in your blood and are infectious, meaning you can spread the virus to others.
  • If you have a reactive antibody test and a positive NAT for HCV RNA, you need to talk to a doctor about treatment. Treatments are available that can cure most people with hepatitis C in 8–12 weeks.

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

After exposure to the hepatitis C virus, it can take 8–11 weeks for an HCV antibody test to be positive. For most people who are infected, the anti-HCV blood test will become positive by 6 months after exposure. A special kind of blood test called a nucleic acid test (NAT) that detects HCV RNA (also called a PCR test) can tell if a person is infected within 1–2 weeks of exposure.

Can a person have normal liver enzyme level and still have hepatitis C?

Yes. For people with hepatitis C, it is common for liver enzyme levels to go up and down, sometimes returning 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.

Treatment

What is the treatment for hepatitis C?

Treatment is recommended for all people, including non-pregnant women, with acute or chronic hepatitis C (including children aged ≥3 years and adolescents). Current treatments usually involve just 8–12 weeks of oral therapy (pills) and cure over 90% with few side effects. The FDA has a list of currently approved FDA treatments for hepatitis C.external icon

 What can people with chronic hepatitis C do to protect the liver?

People with chronic hepatitis C and those with cirrhosis (even if they have been cured of their hepatitis C infection) should be monitored regularly by a doctor, because these people have a continued risk of complications of advanced liver disease, including liver cancer. In addition, people living with hepatitis C should

  • be vaccinated against hepatitis A and hepatitis B
  • avoid alcohol because it can cause additional damage to the liver
  • check with their doctor before taking any prescription pills, herbs, supplements, or over-the-counter medications, as these can potentially damage the liver
  • be tested for HIV, because people who have both infections are more likely to get cirrhosis

Prevention

Is there a vaccine that can prevent hepatitis C?

No. Currently, there is no vaccine to prevent hepatitis C.

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.