Clinical Overview of Hepatitis C

Key points

  • Hepatitis C is transmitted through exposure to infectious blood.
  • Most people with hepatitis C virus (HCV) infection do not have symptoms.
  • The best way to prevent hepatitis C is by avoiding behaviors that can spread the disease.
  • Testing and treatment can prevent complications related to hepatitis C infection and interrupt transmission.
  • Simple, well-tolerated treatments can cure more than 95% of hepatitis C cases.
A 3-d model of the human liver on a table in a doctor's office

Overview

Hepatitis C is a disease of the liver caused by infection from the hepatitis C virus (HCV). The virus is primarily transmitted through exposure to infectious blood or body fluids that contain blood. HCV infection can lead to both acute and chronic liver disease. Curative treatments are available, so early diagnosis and treatment are crucial to prevent severe liver damage and prevent ongoing transmission.

For the public‎

For general audiences looking for information on hepatitis C, visit:
Hepatitis C Disease Overview

Types

Acute hepatitis C occurs within the first 6 months after someone is exposed to HCV. 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. More than half of people who become infected with HCV will develop chronic infection.12 Chronic hepatitis C can cause serious health problems, including liver damage, cirrhosis (scarring of the liver), liver cancer, and even death.

Scientists have identified 7 HCV genotypes and 67 subtypes.3 Genotypes 1a, 1b, 2, and 3 are the most common HCV genotypes in the United States.456 Prior infection with HCV does not protect against later infection involving the same or different genotypes of the virus.

Risk factors

The following populations are at an increased risk for hepatitis C:

  • People who inject drugs or did so in the past.
  • People with human immunodeficiency virus (HIV) infection.
  • People with certain medical conditions, including those who have ever received maintenance hemodialysis and those with persistently abnormal alanine aminotransferase (ALT) (a liver enzyme) levels.
  • People who have received transfusions or organ transplants, including:
    • 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.
  • Health care and public safety personnel who have been exposed to the blood of someone who has hepatitis C (through needle sticks, sharps, or mucosal exposures).
  • Infants born to people with known hepatitis C.

Learn more about at-risk populations.

Incubation period

Most people with hepatitis C do not have symptoms. In people who develop symptoms, the average period from exposure to symptom onset is 2–12 weeks (range: 2–26 weeks).78 Tests can detect viral RNA as early as 1–2 weeks after exposure to the virus.

How it spreads

HCV is transmitted primarily through exposures to infectious blood. Possible exposures include:

  • Injection drug use (currently the most common mode of HCV transmission in the US).9
  • Birth from an HCV-infected person.

Although less frequent, HCV can also be spread through:

  • Sex with an HCV-infected person (although uncommon, HIV-infected men who have sex with men have an increased risk of sexual transmission).
  • Sharing personal items contaminated with infectious blood, such as razors or toothbrushes.
  • Other invasive health care procedures that involve injections.
  • Unregulated tattooing and piercing.
  • Donated blood, blood products, and organs (rare in the US since blood screening became available in 1992).
  • Needlestick injuries in health care settings.

Infection rates and trends

An estimated 2.5 million people in the US had hepatitis C from 2017–2020. 10

Since many people do not have symptoms, they often don't seek treatment from a health care provider and don't get diagnosed. Unrecognized cases aren't reported to public health authorities and thus aren't counted in yearly totals. For example, in 2022, there were 8,848 reported cases of acute hepatitis C, but CDC believes the actual number of acute hepatitis C cases in 2022 was probably closer to 67,400.

During 2022, rates of acute hepatitis C were highest among males, persons ages 20–39 years, non-Hispanic American Indian/Alaska Native (AI/AN) persons, and those living in the Eastern and Southeastern states. Among cases with risk information reported, the most common was injection drug use.

Keep Reading: 2021 Hepatitis C Surveillance

Mortality rates

In 2022, the age-adjusted death rate was 2.9 deaths per 100,000 population.

Nearly 13,000 2021 US death certificates had hepatitis C recorded as an underlying or contributing cause of death.11 This number is considered a conservative estimate because data indicate that most people who die of hepatitis C do not have it listed as a cause of death on their death certificate.12

In 2022, the death rates were 3.3 times higher among Native American populations and 1.7 times higher among non-Hispanic Black people than non-Hispanic White people.

In 2022, hepatitis C-associated death rates were highest among people 55–74 years old compared with other age categories.

Clinical features

Many people with acute or chronic hepatitis C do not look or feel sick and don't know they are infected. If the patient does present with symptoms, they are usually mild and vague.

Learn more about signs and symptoms of HCV infection.

Prevention

There is no vaccine to prevent hepatitis C. Therefore, the best way to prevent hepatitis C is by avoiding behaviors that can spread the disease. If you suspect a patient has been exposed, testing and treatment can prevent complications and interrupt transmission.

Testing, screening, and diagnosis

Testing patients for hepatitis C is important because safe and effective treatments can cure most people in 8–12 weeks. Clinicians should screen all adults aged 18 and older for hepatitis C at least once, and all pregnant persons during each pregnancy. CDC also recommends more frequent testing for people with recognized risk factors or exposures.

There are several blood tests used to diagnose HCV infection. See detailed testing information for hepatitis C.

Clinicians should initiate hepatitis C testing with an FDA-approved HCV antibody test with reflex to nucleic acid test (NAT) for HCV RNA if the antibody test is positive/reactive.

If a patient's antibody test is positive/reactive and they also have detectable HCV RNA, they have a current HCV infection, and you should link them to care.

Learn more about the recommend testing sequence.

Treatment and recovery

Direct-acting antiviral (DAA) treatment is recommended for nearly all people diagnosed with hepatitis C. An 8–12-week course of oral DAA therapy cures more than 95% of people infected with hepatitis C regardless of HCV genotype.13

Treatment saves lives, prevents transmission, and is cost saving.

Hepatitis C can be cured‎

Simple, well-tolerated treatments can cure more than 95% of hepatitis C cases.
Clinical Care and Treatment

Timely treatment is important because, if left untreated, chronic hepatitis C can cause severe liver damage, liver cancer, and even death.

Less than half of people infected with HCV clear it from their bodies without treatment. Experts are still trying to determine how and why this happens.

Patient counseling

Clinicians should talk to their patients diagnosed with HCV about proper treatment, healthy habits, transmission prevention, and potential risks.

Learn more about counseling patients with hepatitis C.

Long-term effects

If untreated, long-term HCV infection can eventually cause chronic liver disease, which can range from mild to severe, including cirrhosis and liver cancer.

Some people with chronic HCV infection develop medical conditions unrelated to the liver. Such conditions can include:

  • Diabetes mellitus
  • Glomerulonephritis
  • Essential mixed cryoglobulinemia
  • Porphyria cutanea tarda
  • Non-Hodgkin's lymphoma

Case definitions

CDC, in collaboration with the Council of State and Territorial Epidemiologists, has developed case definitions to provide uniform clinical and laboratory-testing criteria for identifying and reporting nationally notifiable infectious diseases. Case definitions for acute hepatitis C and chronic hepatitis C are available.

Resources

If you are a clinician looking for more resources on testing, managing, and treating patients with hepatitis C, you can find:

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Content Source:
Division of Viral Hepatitis
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  2. Thomas DL, Seeff LB. Natural history of hepatitis C. Clin Liver Dis. 2005;9(3):383-98.
  3. Smith DB, Bukh J, Kuiken C, Muerhoff AS, Rice CM, Stapleton JT, Simmonds P. Expanded classification of hepatitis C virus into 7 genotypes and 67 subtypes: updated criteria and genotype assignment web resource. Hepatology. 2014;59(1):318-27.
  4. Manos MM, Shvachko VA, Murphy RC, Arduino JM, Shire NJ. Distribution of hepatitis C virus genotypes in a diverse US integrated health care population. J Med Virol. 2012;84(11):1744-50.
  5. Nainan OV, Alter, MJ, Kruszon-Moran D, Gao FX, Xia G, McQuillan G Margolis HS. Hepatitis C virus genotypes and viral concentrations in participants of a general population survey in the United States. Gastroenterology. 2006;131(2):478–84.
  6. Gordon SC, Trudeau S, Li J, et al. Race, age, and geography impact hepatitis C genotype distribution in the United States. J Clin Gastroenterol 2019;53(1):40–50.
  7. National Institute of Diabetes and Digestive and Kidney Diseases. Definition and facts of liver transplant. Available at: https://www.niddk.nih.gov/health-information/liver-disease/liver-transplant/definition-facts.
  8. Organ Procurement and Transplantation Network. Health Resources and Services Administration, US Department of Health and Human Services. National data website. Available at: https://optn.transplant.hrsa.gov/data/view-data-reports/build-advanced.
  9. Centers for Disease Control and Prevention. Viral Hepatitis Surveillance — United States, 2019. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2020. Available at: https://www.cdc.gov/hepatitis/statistics/2019surveillance/index.htm.
  10. Lewis KC, Barker LK, Jiles RB, Gupta N. (2023). Estimated prevalence and awareness of hepatitis C virus infection among US adults: National Health and Nutrition Examination Survey, January 2017–March 2020. Clinical Infectious Diseases, 77(10), 1413–1415. Available at: https://doi.org/10.1093/cid/ciad411.
  11. Centers for Disease Control and Prevention. Viral Hepatitis Surveillance — United States, 2022. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2022. Available at: https://www.cdc.gov/hepatitis/statistics/2022surveillance/hepatitis-c/table-3.8.htm .
  12. Mahajan R, Xing J, Liu SJ, Ly KN, Moorman AC, Rupp L, Xu F, Holmberg SD; Chronic Hepatitis Cohort Study (CHeCs) Investigators. Mortality among persons in care with hepatitis C virus infection: The Chronic Hepatitis Cohort Study (CHeCS), 2006–2010. Clinical Infectious Diseases. 2014;58(8):1055-61.
  13. American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA). Recommendations for testing, management, and treating hepatitis C: HCV testing and linkage to care. Available at: https://www.hcvguidelines.org.