Hepatitis C Questions and Answers for the Public
Index of Questions
- How is hepatitis C spread?
- Can I be re-infected with hepatitis C virus if I have cleared the virus?
- Can hepatitis C virus be spread through sexual contact?
- Can you get hepatitis C by getting a tattoo or piercing?
- Can hepatitis C be spread within a household?
- Who is at risk for hepatitis C?
- What is the risk of a pregnant woman passing hepatitis C to her baby?
- Can a person get hepatitis C virus from a mosquito or other insect bite?
- Can I donate blood if I have tested positive for hepatitis C?
- Can someone with hepatitis C donate organs?
- What are the symptoms of acute hepatitis C?
- How soon after exposure to hepatitis C virus do symptoms appear?
- Can a person spread hepatitis C virus without having symptoms?
- Is it possible to have hepatitis C and not know it?
- What are the symptoms of chronic hepatitis C?
- How serious is chronic hepatitis C?
- What are the long-term effects of hepatitis C?
- Who should get tested for hepatitis C?
- If I am pregnant, should I be tested for hepatitis C?
- Should a woman with hepatitis C virus infection avoid breastfeeding?
- What blood tests are used to test for hepatitis C?
- How do I interpret the results of hepatitis C anti-body test?
- How soon after exposure to the hepatitis C virus can the antibody test tell if someone is infected?
- How soon after exposure to the hepatitis C virus can hepatitis C virus be detected by a hepatitis C virus RNA (PCR) test?
- Can a person have normal liver enzyme (e.g., ALT) level and still have hepatitis C?
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.
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.
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.
Approximately 75%–85% of people who become infected with hepatitis C virus will develop a chronic infection.
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.
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.
In 2016, there were an estimated 2.4 million people living with hepatitis C in the United States.
Transmission / Exposure
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.
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.
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.
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.
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.
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
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.
No, the hepatitis C virus has not been shown to be transmitted by mosquitoes or other insects.
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.
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.
People with new (acute) hepatitis C virus infection usually do not have symptoms or have mild symptoms. When symptoms do occur, they can include:
- Dark urine
- Clay-colored bowel movements
- Abdominal pain
- Loss of appetite
- Joint pain
- Jaundice (yellow color in the skin or eyes)
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.
Yes, even if a person with hepatitis C has no symptoms, he or she can still spread the hepatitis C virus to others.
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.
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.
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.
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.
CDC recommends hepatitis C testing for:
- All adults aged 18 years and older
- All pregnant women during each pregnancy
- People who ever injected drugs and shared needles, syringes, or other drug preparation equipment, including those who injected once or a few times many years ago. Regular testing is recommended for people who currently inject and share needles, syringes, or other drug preparation equipment.
- People with HIV
- People who have ever received maintenance hemodialysis. Regular testing is recommended for people who currently receive maintenance hemodialysis.
- People with persistently abnormal ALT levels
- People who received clotting factor concentrates produced before 1987
- People who received a transfusion of blood or blood components before July 1992
- People who received an organ transplant before July 1992
- People who were notified that they received blood from a donor who later tested positive for HCV infection
- Healthcare, emergency medical, and public safety personnel after needle sticks, sharps, or mucosal exposures to HCV‑positive blood
- Children born to mothers with HCV infection
- Any person who requests hepatitis C testing should receive it.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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[PDF – 2 pages].