Disease Prevention and Control, San Francisco Department of Public Health

Hepatitis C

What is Hepatitis C?

Hepatitis C is a contagious liver infection caused by the hepatitis C virus (HCV).

The hepatitis C virus was discovered in 1989. Prior to that, it was associated with blood transfusions, but was called non-A, non-B hepatitis because the virus could not be identified. It is now known that there are several genetic types (genotypes) of the hepatitis C virus.

The natural course of hepatitis C disease varies from one person to another.

  • The first phase of disease is called acute hepatitis C and covers the first 6 months after a person is infected. During this phase, most people show no symptoms at all. Among those who do have symptoms, the illness is usually so mild that most don’t even recognize that they have liver disease.
  • In 15-40% of persons with acute hepatitis C, the immune system successfully fights off the infection, the virus is cleared from the body within 6 months, and the liver heals completely. In everyone else, the immune system cannot clear the virus, and hepatitis C infection persists past 6 months (usually for the rest of the person’s life). This persistent state is known as chronic hepatitis C.
  • In chronic hepatitis C, the liver becomes more and more inflamed and scarred over a period of years. However, the speed at which inflammation and scarring take place varies between people. About 1/3 develop severe liver scarring and the liver stops functioning normally (cirrhosis) within 20 years. Another 1/3 take 30 years for cirrhosis to occur. In the remaining 1/3, liver disease progresses slowly and does not become a major problem during their lifetime.

Hepatitis C can be treated and cured. Almost everyone living with HCV can now be cured with a one-pill-a-day regimen in eight-to-twelve weeks. These new medications are generally well-tolerated. In order to access HCV treatment, it is necessary to see your doctor to discuss treatment options. Access to treatment continues to improve as new medication regimens are made available by private health insurers and public health programs like the VA Medical Centers, the AIDS Drug Assistance Program, Medicaid, and MediCal.

How do People Get Hepatitis C?

Hepatitis C virus is found in the blood of people with HCV infection. It enters the body through blood-to-blood contact.

Until reliable blood tests for HCV were developed (around 1992), people usually got hepatitis C from blood products and blood transfusions. Now that blood and blood products are tested for HCV, this is no longer the typical means of infection.

Currently, people usually get hepatitis C by sharing needles for injection drug use. An HCV-infected woman can pass the infection to her baby during birth. It is also possible to get hepatitis C from an infected person through sexual contact, an accidental needlestick with a contaminated needle, or improperly sterilized medical, acupuncture, piercing, or tattooing equipment.

Who is at Risk for Infection?

  • People who inject drugs
  • Hemodialysis patients
  • Recipients of blood transfusions, blood products, or solid organ transplants before 1992
  • Infants born to infected mothers
  • Health care and public safety workers who may have contact with blood
  • People having sex with an infected partner

How is Hepatitis C Infection Prevented?

Unfortunately, there is no vaccine to prevent hepatitis C. To reduce your risk of getting hepatitis C:

  • Injection drug use is the most common way people get hepatitis C. Avoid injecting drugs to reduce your risk. If you do inject drugs, use sterile injection equipment. Avoid reusing or sharing.
  • Avoid sharing personal care items that might have blood on them (razors, toothbrushes, nail clippers)
  • If you are a health care or public safety worker, follow universal blood/body fluid precautions and safely handle needles and other sharps
  • Consider the risks if you are thinking about tattooing, body piercing, or acupuncture – are the instruments properly sterilized?
  • If you’re having sex with more than one partner, use latex condoms correctly and every time to prevent the spread of sexually transmitted diseases, including hepatitis C.

What are the Symptoms of Hepatitis C?

During the acute phase (first 6 months after infection) most persons have no symptoms or might experience a mild illness.  Symptoms of acute HCV infection, when present, may include:

  • Jaundice (yellowing of the skin and eyes)
  • Dark-colored urine, light-colored stools
  • Fatigue
  • Abdominal pain
  • Loss of appetite
  • Nausea
  • Diarrhea
  • Fever

During the chronic phase (> 6 months after infection) hepatitis C usually progresses silently, with no symptoms at all during the first 10-20 years. Signs of severe liver scarring (cirrhosis) may include:

  • Ascites (accumulation of fluid and swelling of the abdominal cavity)
  • Star-shaped vein pattern developing on the swollen belly
  • Jaundice
  • Itching
  • Easy bruising and bleeding

Because symptoms of hepatitis C are usually absent, persons with risk for HCV infection should be tested. The blood test for hepatitis C infection is called the “hepatitis C antibody test.” People who have hepatitis C infection will show positive antibodies on this test. In many cases, it is necessary to confirm a positive hepatitis C antibody test with a more specific test, such as a test for HCV virus RNA.

If you think you have hepatitis C or have risk for hepatitis C, you should contact your doctor. The Communicable Disease Control Unit (415-554-2830) may be able to help answer your questions.

Additional Information