Hepatitis C

	Topic Overview
	Health Tools
	Cause
	Symptoms
	What Happens
	What Increases Your Risk
	When To Call a Doctor
	Exams and Tests
	Treatment Overview
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What is hepatitis C?

Hepatitis C is a disease caused by a virus that infects the liver. In time, it can lead to permanent liver damage as well as cirrhosis, liver cancer, and liver failure.

Many people do not know that they have hepatitis C until they already have some liver damage. This can take many years. Some people who get hepatitis C have it for a short time and then get better. This is called acute hepatitis C. But most people who are infected with the virus go on to develop long-term, or chronic, hepatitis C.

Although hepatitis C can be very serious, most people can manage the disease and lead active, full lives.

What causes hepatitis C infection?

Hepatitis C is caused by the hepatitis C virus. It is spread by contact with an infected person's blood.

You can get hepatitis C if:

• You share needles and other equipment used to inject illegal drugs. This is the most common way to get hepatitis C in the United States.
• You had a blood transfusion or organ transplant before 1992. As of 1992 in the United States, all donated blood and organs are screened for hepatitis C.
• You get a shot with a needle that has infected blood on it. This happens in some developing countries where they use needles more than once when giving shots.
• You get a tattoo or a piercing with a needle that has infected blood on it. This can happen if equipment isn't cleaned properly after it is used.

In rare cases, a mother with hepatitis C spreads the virus to her baby at birth, or a health care worker is accidentally exposed to blood that is infected with hepatitis C.

Experts are not sure if you can get hepatitis C through sexual contact. If there is a risk of getting the virus through sexual contact, it is very small.

You cannot get hepatitis C from casual contact such as hugging, kissing, sneezing, coughing, or sharing food or drink.

What are the symptoms?

Most people have no symptoms when they are first infected with the hepatitis C virus. If you do develop symptoms, they may include:

• Feeling very tired.
• Joint pain.
• Belly pain.
• Itchy skin.
• Sore muscles.
• Dark urine.
• Yellowish eyes and skin (jaundice). Jaundice usually appears only after other symptoms have started to go away.

Most people go on to develop chronic hepatitis C but still do not have symptoms. This makes it common for people to have hepatitis C for 15 years or longer before it is diagnosed.

How is hepatitis C diagnosed?

Many people find out that they have the virus by accident, when their blood is tested before a blood donation or as part of a regular checkup. Often, people with hepatitis C will have high levels of liver enzymes in their blood.

If your doctor thinks you may have hepatitis C, he or she will talk to you about having a blood test. If the test shows hepatitis C antibodies, you have had hepatitis C at some point. A second test can tell if you have hepatitis C now.

When blood tests show that you have hepatitis C, you may need a liver biopsy to see if the virus has caused scarring in your liver. During a liver biopsy, a doctor will insert a needle between your ribs to collect a small sample of liver tissue to look at under a microscope. See a picture of the placement of the needle for a liver biopsy.

Some people prefer to find out on their own if they have been exposed to hepatitis C. You can buy a home test called a Home Access Hepatitis C Check kit at most drugstores. If the test shows that you have been exposed to the virus in the past, be sure to talk to your doctor to find out if you have the virus now.

How is it treated?

You and your doctor need to decide if you should take antiviral medicine to treat hepatitis C. It may not be right for everyone. If your liver damage is mild, you may not need medicine.

If you do take medicine, the best treatment is a combination of two medicines that fight infection: peginterferon and ribavirin. How well these medicines work depends on how damaged your liver is, how much virus you have in your liver, and what type of hepatitis C you have.

Taking care of yourself is an important part of the treatment for hepatitis C. Some people with hepatitis C do not notice a change in the way they feel. Others feel tired, sick, or depressed. You may feel better if you exercise and eat healthy foods. To help prevent further liver damage, avoid alcohol and illegal drugs and certain medicines that can be hard on your liver.

Frequently Asked Questions

Health tools help you make wise health decisions or take action to improve your health.

	Decision Points focus on key medical care decisions that are important to many health problems.
	Should I be tested for hepatitis B and C?
	Should I take antiviral therapy for hepatitis C?

Hepatitis C is a liver disease that is caused by infection with the hepatitis C virus, a virus that lives in your liver cells.

How it spreads

You cannot get hepatitis C from casual contact such as hugging, kissing, sneezing, coughing, or sharing food or water with someone. You can get hepatitis C if you come into contact with the blood of someone who has hepatitis C.

The most common way to get hepatitis C is by sharing needles and other equipment (such as cotton, spoons, and water) used to inject illegal drugs. If you are injecting drugs, the best way to protect yourself is by not sharing needles or other equipment with others. Many cities have needle exchange programs that provide free, sterile needles so that you do not have to share needles. If you want to stop using drugs, ask your doctor or someone you trust to help you get into a drug treatment program.

Before 1992, people could get hepatitis C through blood transfusions and organ transplants. Since 1992, all donated blood and organs are screened for hepatitis C, so it is now rare to get the virus this way.

In rare cases, a mother with hepatitis C spreads the virus to her baby at birth, or a health care worker is accidentally exposed to blood that is infected with hepatitis C.

Experts are not sure whether you can get hepatitis C through sexual contact. If there is a risk of getting the virus through sexual contact, it is very small. Your risk is especially low if you are in a long-term, monogamous relationship.

If you live with someone who has hepatitis C or you know someone with hepatitis C, you generally do not need to worry about getting the disease. You can help protect yourself by not sharing anything that may have blood on it, such as razors, toothbrushes, and nail clippers.

Contagious and incubation periods

The incubation period is the time it takes for symptoms to appear after the hepatitis C virus has entered your body, and it is any time from 2 weeks to 6 months.

Anyone who has hepatitis C can spread the virus to someone else. If testing shows you have hepatitis C, do not share needles, and keep cuts, scrapes, and blisters covered.

There are two forms of hepatitis C. The first form is called acute hepatitis C, which means that you recently became infected with the virus. The second form is called chronic hepatitis C, which means that you have had an infection for more than 6 months.

Most people who are infected with hepatitis C develop chronic hepatitis C. But even people who have been infected for a while usually do not have symptoms. This makes it common for people to have hepatitis C for 15 years or longer before it is diagnosed. Many people find out by accident that they have the virus, such as when donating blood or having a routine physical exam.

If symptoms do develop, they may include:

• Fatigue.
• Joint pain.
• Belly pain.
• Itchy skin.
• Sore muscles.
• Dark urine.
• Jaundice, a condition in which the skin and the whites of the eyes look yellow.

Hepatitis C damages your liver very slowly. Approximately 25% of people who have long-term (chronic) hepatitis C will go on to develop severe liver damage and scarring (cirrhosis) after a period of about 20 years or more.¹ If you develop cirrhosis, you may have:

• Redness on the palms of your hands caused by expanded small blood vessels.
• Clusters of blood vessels just below the skin that look like tiny red spiders and usually appear on your chest, shoulders, and face.
• Swelling of your belly, legs, and feet.
• Muscle shrinking.
• Bleeding from enlarged veins in your digestive tract, which is called variceal bleeding. Variceal bleeding can be very serious even though you may not have previous symptoms of the problem.
• Damage to your brain and nervous system, which is called encephalopathy. Encephalopathy can cause symptoms such as confusion and memory and concentration problems.

Many other health problems are associated with long-term cirrhosis. For more information, see the topic Cirrhosis. There also are many other conditions with similar symptoms.

After you are infected with hepatitis C, you will enter an early, shorter-term (acute) stage of the disease. Some people with acute hepatitis C fight off the virus permanently and never have any liver problems. But up to 85% of people who are infected with the virus will go on to develop long-term (chronic) hepatitis C.²

Long-term infection with hepatitis C often causes tiny scars to gradually form in your liver. If you develop a lot of these scars, it becomes hard for your liver to work well. About 25% of people who develop chronic hepatitis C eventually develop more serious liver problems such as cirrhosis or liver cancer, usually over a period of 20 or more years.¹

Acute phase

Most people have no symptoms immediately after they have been infected with hepatitis C. If you do not feel any different than normal, you probably will not know that you have hepatitis C. Even if you go to your doctor because of symptoms, your symptoms may be blamed on the flu. Since any symptoms are likely to go away in a few weeks, you may not know you have hepatitis C for a long time.

If you develop an obvious symptom of hepatitis C such as jaundice, or if you know you have been exposed to the blood of someone with hepatitis C, then you should go to your doctor to be tested for a hepatitis C virus infection.

Chronic phase

You will be diagnosed with chronic (long-term) hepatitis C if your liver has shown signs of infection for at least 6 months.

If you have a chronic infection, you will probably have some liver inflammation even if you do not have symptoms. A chronic infection can last for many years and may never go away. Some people who have chronic hepatitis C never have serious liver problems. Other people develop severe liver problems, such as cirrhosis, liver cancer, or liver failure, usually over a period of 20 years or longer. If the infection becomes so severe that your liver can no longer function (end-stage liver failure), having a liver transplant may be the only way to extend your life.

Hepatitis C mostly causes damage to the liver. Occasionally, it also plays a role in the development of other health problems.

Certain factors may increase your risk of becoming infected with the hepatitis C virus. Just because you are at risk for getting hepatitis C does not mean that you have the virus. But if you are at risk, talk to your doctor about whether you should be tested.

Risk factors you can control include:

• Sharing needles and other equipment (such as cotton, spoons, and water) used to inject drugs.
• Having your ears or another body part pierced, getting a tattoo, or having acupuncture with needles that have not been sterilized properly. The risk of getting hepatitis C in these ways is very low.
• Working in a health care environment where you are exposed to fresh blood or where you may be pricked with a used needle. Following standard precautions for health care workers makes this risk very low.

Risk factors you cannot control include:

• Having had a blood transfusion or organ transplant before 1992. Starting in 1992, all donated blood and organs were screened for hepatitis C.
• Having been exposed to unsafe practices for giving shots, such as reusing needles. This occurs in some developing countries.
• Needing to have your blood filtered by a machine (hemodialysis) because your kidneys cannot filter your blood.
• Being born to a mother who has hepatitis C. The risk of passing the virus to a child is greater if the mother is also infected with HIV.

Should I be tested for hepatitis B and C?

Call 911 or other emergency services immediately if you have hepatitis C and you:

• Feel extremely confused or are having hallucinations.
• Are bleeding from the rectum or are vomiting blood.

Call your doctor if:

• You think you may have been infected with hepatitis C.
• You have risk factors for hepatitis C, such as IV drug use.
• You develop symptoms of hepatitis C (fatigue, sore muscles, loss of appetite, nausea, dark urine or yellow-gray stools, fever, or jaundice) and you think you may have been exposed to hepatitis C.
• A home test for hepatitis C virus shows that you have hepatitis C. More testing is needed to determine if you have an active infection.

Watchful Waiting

Taking a wait-and-see approach (called watchful waiting) is not appropriate if you think you have hepatitis C. Talk to your doctor if you think you have been exposed to hepatitis C.

Who To See

The following health professionals can diagnose hepatitis C:

• Family medicine physician
• Internist
• Pediatrician
• Physician assistant
• Nurse practitioner
• Gynecologist

The following specialists also can diagnose the disease and provide further care:

• Gastroenterologist
• Hepatologist
• Infectious disease specialist

To prepare for your appointment, see the topic Making the Most of Your Appointment

Asking questions about your medical history and doing a physical exam will help your doctor determine your chances of having hepatitis C. Often, people find out by accident that they have hepatitis C, such as when donating blood or having a routine physical exam. High liver enzymes in your blood may be the first sign of the virus.

To check how well your liver is working, you may have liver function tests. These are blood tests that can help your doctor find out if you have liver damage.

If your doctor thinks that you may have hepatitis C, he or she will order a hepatitis C virus test. This is a blood test that looks for antibodies against the hepatitis C virus. If you have hepatitis C antibodies, you will have another blood test that looks for the genetic material (RNA) of the hepatitis C virus. The antibody test shows whether you have been exposed to the virus, and the RNA test shows whether you are infected with the virus now. Before having these tests, your doctor should talk to you about the pros and cons of testing for hepatitis C so that you understand what having the virus means.

If your test results are positive, your doctor may order a liver biopsy to see whether the virus has caused scarring or damage to your liver. During a liver biopsy, a doctor will insert a needle between your ribs to collect a small sample of liver tissue to be examined under a microscope. See a picture of the placement of the needle for a liver biopsy.

Your doctor also may order some imaging tests such as a CT scan, MRI, or ultrasound to make sure that you do not have liver cancer. You also may have a blood test to determine the kind of hepatitis C virus (genotype) you have. Knowing your genotype and the extent of your liver damage will help you and your doctor decide if and how you should be treated.

Early Detection

You should be tested for hepatitis C if you:

• Have signs or symptoms of liver disease, such as abnormal liver tests.
• Received blood from a donor who was found to have hepatitis C.
• Have ever shared needles while using drugs, even if you only experimented many years ago.
• Are a health care worker who may have been exposed to hepatitis C through a needle stick or other contact with blood or body fluids.
• Have a sex partner who has a chronic hepatitis C infection.
• Have had your blood filtered by a machine (hemodialysis) because your kidneys cannot filter your blood.
• Received blood, blood products, or a solid organ from a donor before 1992. Since 1992, all donated blood and organs are screened for hepatitis C, so it is now rare to get the virus this way.
• Received blood-clotting factor concentrates (used to treat blood disorders such as hemophilia) before 1987. In 1987, screening of clotting factor concentrates for hepatitis C became a requirement.

Some people prefer to find out on their own whether they have been exposed to hepatitis C. In most drugstores you can buy a home test called the Home Access Hepatitis C Check kit. If test results show that you have been exposed to the virus, it is important to discuss these results with your doctor and to find out if you are infected with the virus now.

Should I be tested for hepatitis B and C?

If you are diagnosed with hepatitis C, your doctor will talk to you about how to prevent spreading the virus. He or she also will recommend that you protect your liver by getting shots to prevent hepatitis A and hepatitis B. You may also get tested for HIV. Your doctor also may talk to you about how alcohol can damage your liver.

Being diagnosed with hepatitis C can change your life. You may feel angry or depressed about having to live with a long-term (chronic), serious disease. You may have a hard time knowing how to tell other people that you have the virus. It can be helpful to talk with a social worker or counselor about what having the disease means to you. You also may want to find a support group for people with hepatitis C. If you do not have a support group in your area, there are several on the Internet.

You may or may not receive treatment for hepatitis C, depending on how damaged your liver is, other health conditions you have, how much virus you have in your body, and what type (genotype) of hepatitis C you have. Treatment is not always an option, because the medicines used to treat hepatitis C have serious side effects, are expensive, and do not work for everyone.

The goal of treatment for hepatitis C is to eliminate the virus from your body early, to prevent serious liver problems. The length of treatment for hepatitis C depends on whether you have a short-term (acute) infection or a long-term (chronic) infection. It may also depend on the type of hepatitis C virus causing the infection and how well the medicine seems to be working.

Treatment of short-term (acute) hepatitis C

Most people with acute hepatitis C do not get treated, because they do not know they have the virus.

If a person knows that he or she may have been exposed to the virus—such as a health care worker who is stuck by a needle—acute hepatitis C can be identified early. Most people who are known to have an acute hepatitis C infection get treated with medicine. In these cases, treatment for acute hepatitis C may help prevent long-term (chronic) infection, although there is still some debate over when to begin treatment and how long to treat acute hepatitis C.^{3, 4}

Treatment of long-term (chronic) hepatitis C

It is common for people to live with hepatitis C for years without knowing they have it, simply because they do not have symptoms. Most people diagnosed with hepatitis C find out that they already have long-term, chronic infection. If your blood tests and liver biopsy show that you have chronic infection but no damage to your liver, you may not need treatment. If you do have some liver damage, you may be treated with a combination of medicines that fight the viral infection.

Whether or not you take medicines to treat hepatitis C, you will need to have routine blood tests to help your doctor know how well your liver is working.

If you decide not to be treated with medicines, your doctor will want to monitor you closely and may want to do a liver biopsy every 4 or 5 years to check for damage in your liver.

Some people who originally decide not to have treatment for hepatitis C later decide they want to try antiviral medicines.

Antiviral medicines for hepatitis C may not be recommended if you:

• Drink alcohol or use IV drugs. (Although you cannot take antiviral medicines if you use IV drugs, you can take antiviral medicines if you are using methadone.)
• Have advanced cirrhosis.
• Have severe depression or other mental health problems. The antiviral medicines used to treat hepatitis C can make mental health problems worse.
• Are pregnant or might become pregnant. Two forms of birth control must be used during treatment and for 6 months after treatment, because the medicines used to treat hepatitis C can harm a fetus.
• Have an autoimmune disease such as lupus, rheumatoid arthritis, or psoriasis, or certain medical problems such as advanced diabetes, heart disease, or seizures.

The U.S. National Institutes of Health has made recommendations on who should receive antiviral treatment for hepatitis C.⁵ For example, treatment is recommended for people who are at least 18 years old, have detectable levels of the virus in their blood, and have significant liver damage confirmed by a liver biopsy.

Only a few clinical trials have tested antiviral medicines in children. The results suggest that they work about as well in children as in adults. Combination therapy using interferon and ribavirin is now approved by the U.S. Food and Drug Administration (FDA) for use in children ages 3 to 17 years.

Antiviral medicines to treat hepatitis C include:

• Peginterferon and other interferons, which are similar to a protein your body makes to fight off infection.
• Combination antiviral therapy with interferons and ribavirin, which increases your chances of getting rid of the virus in your body.

Peginterferon—a newer, longer-acting form of interferon—combined with ribavirin is now considered better than standard interferon combined with ribavirin. Peginterferon is given as a weekly shot, and ribavirin is taken as a pill 2 times a day.

The length of your treatment depends on what hepatitis C genotype you have. Genotype 1 generally is treated for 1 year and genotypes 2 and 3 generally are treated for 6 months. The amount of virus in your body (viral load) will be checked while you are being treated. If you have genotype 1 and your viral load does not improve after 3 months of treatment, your treatment may be stopped.

Even if medicines are recommended for you, they may not work or they may not work long-term. Chronic hepatitis C infection is cured or controlled in about half of people who are treated with a combination of peginterferon and ribavirin.⁶ Studies have shown that treatment works for up to 50% of people with genotype 1 and up to 80% of people with genotype 2 or 3.⁷

Sometimes, treatment does not permanently lower the amount of virus in your blood. But some studies have shown that treatment may still reduce scarring in your liver, which can lower your chances of developing cirrhosis and liver cancer.^{5, 2}

Medicines for hepatitis C are expensive and can cause many serious side effects, such as constant fatigue, headaches, fever, nausea, depression, and thyroid problems.

It is important to weigh the benefits of medicines for hepatitis C against the drawbacks. You most likely do not need to make a quick decision about treatment, because hepatitis C progresses very slowly. Talking with your doctor can help you decide whether medicines are right for you. For more information, see:

Should I have antiviral therapy for hepatitis C?

Treatment of relapse or nonresponse

Sometimes, you can take more medicine if your first round of treatment did not work very well. The decision to try treatment again is based on how well you tolerated the first treatment, how well the first round of treatment worked, the dose of the first treatment, and the genotype of your virus. Talk to your doctor about whether you might try medicines again.

Treatment if the condition gets worse

Severe liver damage caused by chronic hepatitis C usually takes 20 or more years to develop. If you have hepatitis C, there are certain factors that may help you predict your risk of severe liver damage.

If your hepatitis C continues to get worse, it can cause your liver to stop working, a condition called end-stage liver failure. In this case, a liver transplant may be the only way to extend your life. But if you are using alcohol, are sharing needles to inject drugs, or have severe depression or certain other mental illnesses, liver transplant may not be an option.

End-of-life issues

Most people with chronic hepatitis C will not die from the disease. But between 1% and 5% of people with severe liver damage from chronic hepatitis C will die due to hepatitis C.⁸ Even if a liver transplant is done as a last possible treatment, there can be complications that lead to death. For more information about death and dying, see the topic Care at the End of Life.

What To Think About

If you have chronic hepatitis C, you can help keep the disease from getting worse. You can do this by not drinking alcohol, not sharing needles for drug use, eating well, and not taking any herbal supplement unless your doctor tells you it is okay.

There is no vaccine for hepatitis C, but there are vaccines for hepatitis A and hepatitis B. Your doctor may recommend that you have these vaccines to help protect you from more liver problems.

The U.S. National Institutes of Health has made recommendations on who should receive antiviral treatment for hepatitis C.⁵ For example, treatment is recommended for people who are at least 18 years old, have detectable levels of the virus in their blood, and have significant liver damage confirmed by a liver biopsy. If you do not meet these criteria, your decision to try antiviral treatment is more complicated.

Antiviral therapy is expensive, and the medicines can cause many serious side effects, including constant fatigue, nausea, headaches, depression, and thyroid problems.

Researchers are working to develop other treatments, including gene therapy and medicines that help control the immune system. A new medicine called viramidine is also being studied as a substitute for ribavirin. Viramidine may cause less anemia than ribavirin causes.⁹

There is no vaccine to prevent hepatitis C, but you can reduce your risk of becoming infected if:

• You do not share needles to inject drugs. If you are injecting drugs, the best way to protect yourself is by not sharing needles or other equipment (such as cotton, spoons, and water) with others. Many cities have needle exchange programs that provide free, sterile needles so that you do not have to share needles. If you want to stop using drugs, ask your doctor or someone you trust to help you find out about drug treatment programs.
• You work in a health care setting and you follow your institution's safety guidelines. You wear protective gloves and clothing and dispose of needles and other contaminated sharp objects properly.
• You make sure the practitioner sterilizes the instruments and supplies if you get a tattoo, have your body pierced, or have acupuncture.

If you have hepatitis C, you can help prevent spreading it to others if:

• You do not share needles or other equipment such as cotton, spoons, and water if you continue to use needles to inject drugs.
• You keep cuts, scrapes, and blisters covered to prevent others from coming in contact with your blood and other body fluids. Throw out any blood-soaked items such as used Band-Aids.
• You do not donate blood or sperm.
• You wash your hands—and any object that has come in contact with your blood—thoroughly with water and soap.
• You do not share your toothbrush, razor, nail clippers, diabetes supplies, or anything else that might have your blood on it.

Breast-feeding mothers who have hepatitis C can continue to breast-feed their babies because hepatitis C cannot be spread through breast milk. If you are breast-feeding, you should try to avoid having cracked nipples, which might pose a risk of spreading the virus to your baby. For more information, see the topic Breast-Feeding.

Some people with hepatitis C do not notice a big difference in the way they feel. Others feel tired, sick, or depressed. The following are steps you can take at home that may help you feel better both physically and emotionally.

Slow down

It is very common to feel tired if you have hepatitis C. If you feel tired, give yourself permission to do less and rest more. If possible, ask others to help out around your home or ask your employer for a shorter or more flexible work schedule.

Exercise

Exercise if you feel up to it. Aerobic exercise can help you have more energy and may also improve depression. It is best to avoid any strenuous activities on the day after you receive peginterferon.⁷

Eat regular, nutritious meals

Sometimes people with hepatitis C have a hard time eating. You may have no appetite, feel nauseated, or have different tastes than you are used to. Even if you do not feel like eating, it is very important to eat small meals throughout the day. Some people experience nausea in the afternoon. If this happens to you, try to eat a big, nutritious meal in the morning.

If you have cirrhosis, it may not be a good idea to eat salty foods or foods that are high in protein. If you want to know more about which foods to avoid and which foods are good to eat, ask your doctor about meeting with a registered dietitian to discuss a healthy eating plan.

Avoid alcohol and drugs

One of the most important jobs of your liver is to break down drugs and alcohol. If you have hepatitis C, one of the best things you can do is to avoid substances that may harm your liver such as alcohol and illegal drugs. If you have cirrhosis, you also may need to avoid certain medicines.

If you use illegal drugs or alcohol, it is important to stop. Being honest with your doctor about your drug and alcohol use will help you deal with any substance abuse problems. If you do not feel that you can talk openly with your doctor, you may want to find a doctor you feel more comfortable with. If you want to stop using drugs or alcohol and need help to do so, ask your doctor or someone else you trust about drug and alcohol treatment options.

Because many medicines can stress your liver, talk to your doctor before you take any prescription or over-the-counter medicines. This includes herbal remedies as well.

Control itching

If you develop itchy skin, ask your doctor about taking nonprescription medicines, such as diphenhydramine (for example, Benadryl) or chlorpheniramine (for example, Chlor-Trimeton), to relieve itching. If you do take these medicines, be sure to follow the instructions and to stop using the medicine if you have any side effects.

Seek help for depression

Depression may develop in anyone who has a long-term illness. It also can be a side effect of antiviral medicines for hepatitis C. If you are feeling depressed, talk to your doctor about antidepressant medicines and/or counseling. For more information, see the topic Depression.

Learn about the disease

Learning about hepatitis C may help you feel more in control of the disease. The more you understand, the better you can make decisions about treatment and lifestyle changes that may help you feel better, both physically and emotionally.

Antivirals are the only medicines used to treat long-term (chronic) hepatitis C. These medicines can help prevent the hepatitis C virus from damaging your liver. If these medicines work for you, you may have no more virus in your body and less inflammation and scarring in your liver.

Medication Choices

The following antiviral medicines are used to treat chronic hepatitis C:

• Peginterferons, which are similar to a protein your body makes to fight off infection
• Combination antiviral therapy with interferons and ribavirin, which increases your chances of getting rid of the virus in your body

What To Think About

Antiviral medicines for hepatitis C may not be recommended if you:

• Drink alcohol or use IV drugs. (Although you cannot take antiviral medicines if you use IV drugs, you can take antiviral medicines if you are using methadone.)
• Have advanced cirrhosis.
• Have severe depression or other mental health problems. The antiviral medicines used to treat hepatitis C can make mental health problems worse.
• Are pregnant or might become pregnant. Two forms of birth control must be used during treatment and for 6 months after treatment.
• Have an autoimmune disease such as lupus, rheumatoid arthritis, or psoriasis, or certain medical problems such as advanced diabetes, heart disease, or seizures.

The U.S. National Institutes of Health has made recommendations on who should receive antiviral treatment for hepatitis C.⁵ For example, treatment is recommended for people who are at least 18 years old, have detectable levels of the virus in their blood, and have significant liver damage confirmed by a liver biopsy.

Only a few clinical trials have tested antiviral medicines in children. The results suggest that they work about as well in children as in adults. Combination therapy using interferon and ribavirin is now approved by the U.S. Food and Drug Administration (FDA) for use in children ages 3 to 17 years.

Medicines for hepatitis C are expensive and can cause many serious side effects, such as constant fatigue, headaches, fever, nausea, depression, and thyroid problems.

The length of your treatment depends on what hepatitis C genotype you have. Genotype 1 generally is treated for 1 year and genotypes 2 and 3 generally are treated for 6 months. If you have genotype 1 and your viral load does not show signs of improvement after 3 months of treatment, your treatment may be stopped.

It is important to weigh the benefits of medicines for hepatitis C against the drawbacks. You most likely do not need to make a quick decision about treatment, because hepatitis C progresses very slowly. Talking with your doctor can help you decide whether medicines are right for you. For more information, see:

Should I have antiviral therapy for hepatitis C?

Treatment effectiveness

Peginterferon—a newer, longer-acting form of interferon—combined with ribavirin is now considered better than standard interferon combined with ribavirin.

Medicines to treat hepatitis C do not work for everyone. Chronic hepatitis C infection is cured or controlled in about half of the people who are treated with a combination of peginterferon and ribavirin.⁶ Studies have shown that treatment works for up to 50% of people with genotype 1 and up to 80% of people with genotype 2 or 3.⁷

Most people who are known to have an acute hepatitis C infection get treated with medicine. In these cases, treatment for acute hepatitis C may help prevent long-term (chronic) infection, although there is still some debate over when to begin treatment and how long to treat acute hepatitis C.^{3, 4}

Sometimes treatment does not permanently lower the amount of virus in your blood. But some studies have shown that treatment may still reduce scarring in your liver, which can lower your chances of developing cirrhosis and liver cancer.^{5, 2}

If you have tried interferon in the past and did not get good results, talk to a doctor who is a liver specialist (hepatologist). The hepatologist will be able to tell you about newer combinations of peginterferon with ribavirin or new, experimental medicines.

If chronic hepatitis C damages your liver so severely that it no longer works well (end-stage liver failure), you may need a liver transplant to extend your life. Liver transplants are not common.

Surgery Choices

A liver transplant is the only surgical treatment that can help people with end-stage liver failure.

What To Think About

Liver transplantation is a risky, expensive procedure, and donor organs are hard to come by. Most of the time, only people who are in good health (other than having liver disease) are considered for a transplant. You will not be considered if you are using alcohol or drugs or have certain mental health problems.

After a liver transplant, you will need lifelong follow-up care by a specialist. You also will need to take immunosuppressant medicine to keep your body from rejecting the new liver, which may cause you to develop other problems.

Hepatitis C almost always infects the newly transplanted liver. Recurring liver disease after a transplant can be a serious problem and may cause the new organ to fail. But most patients do very well after a liver transplant and are able to live normal lives.

Some people seek out complementary medicines or alternative ways to treat their hepatitis C. At this time, no complementary or alternative medicines have been proven to reduce symptoms or cure hepatitis C. In fact, some herbal therapies (such as kava) can actually damage the liver.

Preliminary studies of the herb milk thistle do show that it may help protect the liver from inflammation.¹⁰ The U.S. National Center for Complementary and Alternative Medicine currently is conducting a clinical trial on the use of milk thistle for hepatitis C. Talk to your doctor if you are thinking about trying milk thistle or any other complementary therapy to treat hepatitis C.

Organizations

• Cirrhosis
• Depression
• Hepatitis A
• Hepatitis B

Citations

1. Flamm SL (2003). Chronic hepatitis C virus infection. JAMA, 289(18): 2413–2417.

2. Dienstag JL (2005). Chronic viral hepatitis. In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 6th ed., vol. 1, pp. 1441–1464. Philadelphia: Elsevier/Churchill Livingstone.

3. Wiegand J, et al. (2006). Early monotherapy with pegylated interferon alfa-2b for acute hepatitis C infection: The HEP-NET Acute HCV-II Study. Hepatology, 43(2): 250–256.

4. Jaeckel E, et al. (2001). Treatment of acute hepatitis C with interferon alfa-2b. New England Journal of Medicine, 345(20): 1452–1457.

5. Management of hepatitis C: 2002. Consensus Development Conference statement, National Institutes of Health Consensus Development Conference (2002 June 10–12). NIH Consensus Development Program. Available online: http://consensus.nih.gov/2002/2002HepatitisC2002116html.htm.

6. Lindsay KL, Hoofnagle JH (2004). Chronic hepatitis C. In L Goldman, JC Bennett, eds., Cecil Textbook of Medicine, 22nd ed., vol. 1, pp. 917–924. Philadelphia: Saunders.

7. Ward RP, et al. (2004). Management of hepatitis C: Evaluating suitability for drug therapy. American Family Physician, 69(6): 1429–1438.

8. National Center for Infectious Diseases, Centers for Disease Control and Prevention (2005). Viral hepatitis C: Fact sheet. Available online: http://www.cdc.gov/ncidod/diseases/hepatitis/c/fact.htm.

9. McHutchison JG, et al. (2007). Strategies for managing anemia in hepatitis C patients undergoing antiviral therapy. American Journal of Gastroenterology, 102(4): 880–889.

10. National Center for Complementary and Alternative Medicine (2003). Hepatitis C and Complementary and Alternative Medicine: 2003 Update (NCCAM Publication No. D004). Washington, DC: U.S. Department of Health and Human Services. Available online: http://nccam.nih.gov/health/hepatitisc.

Other Works Consulted

• Craxi A, Licata A (2006). Acute hepatitis C: In search of the optimal approach to cure. Hepatology, 43(2): 221–224.

• Liu JP, et al. (2006). Medicinal herbs for hepatitis C virus infection. Cochrane Database of Systematic Reviews (4). Oxford: Update Software.

• Myers RP, et al. (2006). Interferon for acute hepatitis C. Cochrane Database of Systematic Reviews (4). Oxford: Update Software.

• Sulkowski MS, Thomas DL (2003). Hepatitis C in the HIV-infected person. Annals of Internal Medicine, 138(3): 197–207.