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Hepatitis C, Acute

By Anna E. Rutherford, MD, MPH, Assistant Professor of Medicine;Clinical Director of Hepatology, Harvard Medical School;Brigham and Women’s Hospital

Acute hepatitis C is inflammation of the liver that is caused by the hepatitis C virus and that lasts from a few weeks up to 6 months.

  • Hepatitis C is spread through contact with blood or other bodily fluids of infected people, as occurs when people share unsterilized needles to inject illicit drugs.

  • Acute hepatitis C often causes no symptoms

  • Doctors diagnose acute hepatitis C based on blood tests.

  • No vaccine is available.

  • Often, no specific treatment is recommended for acute hepatitis C.

In the United States, about 2,000 cases of acute hepatitis C are reported each year. However, because many cases are not recognized or not reported, the actual number of new infections is estimated to be close to 30,000 each year.

For unknown reasons, about one of five people with alcoholic liver disease has hepatitis C. In these people, alcohol and hepatitis C work together to worsen inflammation and scarring of the liver (cirrhosis).

Transmission of hepatitis C

Hepatitis C is usually spread through contact with blood of an infected person. Hepatitis C is most commonly transmitted among people who share unsterilized needles to inject illicit drugs. The infection can also be transmitted through unsterilized needles used for tattoos and body piercings.

Transmission through blood transfusions or organ transplants is possible but is now rare. Such transmission was common in the United States until 1992, when widespread screening of the blood supply for the hepatitis C virus began.

Transmission through sexual contact is uncommon, as is transmission from an infected pregnant woman to her baby.

Why someone gets hepatitis C sometimes cannot be determined.

Symptoms

At first, acute hepatitis C is usually mild and often causes no symptoms.

Some people with acute hepatitis C have typical symptoms of viral hepatitis. These symptoms include

  • Loss of appetite

  • A general feeling of illness (malaise)

  • Fever

  • Nausea and vomiting

  • Jaundice (yellowing of the skin and whites of the eyes)

Acute hepatitis C very rarely becomes severe (fulminant).

Hepatitis C becomes chronic in about 75% of people. Chronic infection is usually mild. However, about 20 to 30% of people with chronic hepatitis C develop cirrhosis. Liver cancer may develop but usually only after cirrhosis has developed.

Diagnosis

  • Blood tests

Doctors suspect acute hepatitis C when

  • People have symptoms of acute hepatitis.

  • Blood tests (liver function tests) detect inflammation of the liver (hepatitis).

Testing usually begins with blood tests to determine how well the liver is functioning and whether it is damaged (liver function tests). Liver function tests involve measuring the levels of liver enzymes and other substances produced by the liver.

Blood tests are done to look for other causes of hepatitis.

Blood tests that are specific for hepatitis C virus are done. These tests check for

  • Antibodies produced by the person's immune system in response to the hepatitis C virus

  • Genetic material of the hepatitis C virus (hepatitis C virus RNA)

The presence of antibodies to hepatitis C suggests that people have been infected with hepatitis C at some time in their life but are not necessarily still infected. If antibodies to hepatitis C are found, the hepatitis C RNA test is done to determine whether the infection is current or occurred in the past.

Prevention

High-risk behavior, such as sharing needles to inject drugs, should be avoided.

All blood donors are tested for hepatitis C to prevent the spread of hepatitis C virus through transfusions. Also, even though the chance of getting hepatitis from transfusions is remote, doctors use transfusions only when there is no alternative. These measures have dramatically decreased the risk of getting hepatitis from a blood transfusion.

No vaccine for hepatitis C is currently available.

Treatment

  • General measures

Acute hepatitis C is not routinely treated with antiviral drugs because the infection goes away on its own, without treatment, in about one fourth of people who have it.

The same drugs used to treat chronic hepatitis C may reduce the risk of acute hepatitis C becoming chronic. However, such treatment has not been well-studied and is expensive. So doctors typically wait 6 months to see if hepatitis goes away on its own. If it does not, treatment is considered.

People with hepatitis C should not drink alcohol because it can damage the liver further. There is no need to avoid certain foods or to limit activity.

Most people can safely return to work after jaundice resolves.

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