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Hepatitis C, Chronic


Sonal Kumar

, MD, MPH, Weill Cornell Medical College

Reviewed/Revised Aug 2022 | Modified Sep 2022

Chronic hepatitis C is inflammation of the liver that is caused by the hepatitis C virus and that has lasted more than 6 months.

  • Hepatitis C often causes no symptoms until after it has badly damaged the liver.

  • Doctors diagnose chronic hepatitis C based on blood tests.

  • If chronic hepatitis C has caused cirrhosis, screening for liver cancer is done every 6 months.

  • Chronic hepatitis C is treated with antiviral drugs.

Acute hepatitis C becomes chronic in about 75% of affected people.

From 2013 to 2016, an estimated 2.4 million people in the United States had chronic hepatitis C. Worldwide, 71 million people are estimated to have chronic hepatitis C.

Chronic hepatitis C, if untreated, causes cirrhosis Cirrhosis of the Liver Cirrhosis is the widespread distortion of the liver's internal structure that occurs when a large amount of normal liver tissue is permanently replaced with nonfunctioning scar tissue. The scar... read more Cirrhosis of the Liver in about 20 to 30% of people. However, cirrhosis may take decades to develop. The risk of liver cancer is increased usually only if cirrhosis is present.

There are different types (genotypes 1 through 6) of hepatitis C virus, which are sometimes treated with different drugs.

Symptoms of Chronic Hepatitis C

Many people with chronic hepatitis C have no symptoms. Some have a feeling of being generally ill (malaise), loss of appetite, fatigue, and vague abdominal discomfort.

Often, the first specific symptoms are those of cirrhosis or complications of cirrhosis. These symptoms can include

Brain function deteriorates because the badly damaged liver cannot remove toxic substances from the blood as it normally does. These substances then build up in the blood and reach the brain. Normally, the liver removes them from the blood, breaks them down, then excretes them as harmless by-products into the bile (the greenish yellow fluid that aids in digestion) or blood (see Functions of the Liver Functions of the Liver ). Treatment of hepatic encephalopathy can prevent the deterioration of brain function from becoming permanent.

Screening for Chronic Hepatitis C

Certain people should talk to their doctor about being tested for hepatitis C, whether they have symptoms suggesting hepatitis or not. One routine screening is recommended for all people 18 years old or over, regardless of risk factors.

One screening is also recommended for people under 18 years old with the following characteristics:

  • Are currently using or have ever injected illicit drugs, even if only one time

  • Have inhaled illicit drugs

  • Are men who have sex with men

  • Are currently or have ever been treated with long-term hemodialysis

  • Have abnormal liver test results or unexplained chronic liver disease

  • Work in health care or public safety and were exposed to blood of a person with hepatitis C through a needlestick or other injury by a sharp object

  • Have HIV infection or are starting to take an antiretroviral drug before being exposed to HIV

  • Have ever been imprisoned

  • Are children born to women with hepatitis C

Such testing is important because symptoms may not develop until the infection has extensively damaged the liver, years after people are first infected.

Diagnosis of Chronic Hepatitis C

  • Blood tests

Doctors may suspect chronic hepatitis C when

  • People have typical symptoms.

  • Blood tests (done for other reasons) detect abnormally high liver enzymes.

  • People have been previously diagnosed with acute hepatitis C.

Testing for chronic hepatitis usually begins with blood tests to determine how well the liver is functioning and whether it is damaged (liver tests Liver Blood Tests Liver tests are blood tests that represent a noninvasive way to screen for the presence of liver disease (for example, viral hepatitis in donated blood) and to measure the severity and progress... read more ). Liver tests involve measuring the levels of liver enzymes and other substances produced by the liver. These tests may help establish or exclude the diagnosis of hepatitis C and determine the severity of liver damage.

If tests suggest hepatitis, doctors do other blood tests to check for hepatitis B and C virus. Both can cause chronic hepatitis. These blood tests can identify parts of specific viruses (antigens), specific antibodies produced by the body to fight the virus, and sometimes genetic material (RNA or DNA) of the virus. If doctors strongly suspect only chronic hepatitis C, they may do blood tests for only that virus.

If chronic hepatitis C is confirmed, doctors also check for HIV infection and hepatitis B because these infections are often spread in the same ways—through contact with bodily fluids, such as blood or semen.

After hepatitis C is diagnosed, tests may be done to determine how badly the liver is damaged and to check for other causes of liver disease. Tests may include

Ultrasound elastography and magnetic resonance elastography use sound waves, applied to the abdomen, to determine how stiff the liver tissue is.

Screening for liver cancer

  • Ultrasonography

  • Sometimes blood tests to measure the level of alpha-fetoprotein

The level of alpha-fetoprotein—a protein normally produced by immature liver cells in fetuses—usually increases when liver cancer is present.

Treatment of Chronic Hepatitis C

  • Antiviral drugs

Chronic hepatitis C is treated with antiviral drugs called direct-acting antiviral drugs. Usually, several drugs are used together.

Chronic hepatitis C should be treated unless the person has another disorder that does not respond to treatment and that shortens life expectancy.

Treatment varies based on the genotype of hepatitis C virus causing the infection, degree of damage to the liver, and prior treatment for hepatitis C.

Many direct-acting antiviral drugs are available to treat hepatitis C. These drugs are highly effective and have minimal side effects because they target the virus directly. They include sofosbuvir, elbasvir, grazoprevir, velpatasvir, glecaprevir, ledipasvir, voxilepravir, and pibrentasvir (all taken by mouth).

Treatment can last from 8 to 24 weeks. Treating hepatitis C can eliminate the virus from the body and thus stop inflammation and prevent scarring, reducing the risk of developing cirrhosis.

Ribavirin is sometimes added to the treatment regimen to boost the effectiveness of the antiviral drugs. However, ribavirin can cause birth defects. Both men and women who have to take these drugs should use birth control during treatment and for 6 months after treatment ends.

If chronic hepatitis C infection has severely damaged the liver, liver transplantation may be done. After liver transplantation, people with hepatitis C are often treated with antiviral drugs, which improve their chance of being cured.

After treatment is completed, doctors do blood tests to determine how much of the virus's genetic material is present. If none is detected 12 weeks after treatment is completed, people are probably cured.

More Information

The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

  • Centers for Disease Control and Prevention: Hepatitis C questions and answers for the public: This web site provides an overview of hepatitis C (including definitions, and statistics) and information about transmission, symptoms, testing, treatment, and hepatitis C and employment. Accessed May 19, 2022.

Drugs Mentioned In This Article

Generic Name Select Brand Names
Copegus, Moderiba, Rebetol, RibaPak, Ribasphere, Ribasphere RibaPak, RibaTab, Virazole
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