HCV Overview

What is Hepatitis C?

Hepatitis C is an infection of the liver resulting from the hepatitis C virus. Approximately 80% of people who contract hepatitis C develop a chronic infection.¹ For reasons that are not well understood, about 20% of people who contract hepatitis C spontaneously clear the virus.² This means a person’s immune system is able to fight off and eliminate the hepatitis C virus on its own without treatment. Chronic hepatitis C can cause liver damage, cirrhosis (scarring of the liver), liver failure, or liver cancer, as well as other conditions outside of the liver, although these outcomes usually occur over a period of several years.

Transmission

Hepatitis C is transmitted when the blood of a person living with hepatitis C enters the body of someone who does not have the virus. Today, in the United States, most people acquire hepatitis C through sharing needles, syringes, or other equipment used for injecting drugs. Before widespread blood supply screening began in 1992, hepatitis C was also spread through blood transfusions and organ transplants. Although uncommon, poor infection control can lead to outbreaks in healthcare settings. Vertical transmission occurs in about 5% of cases when a parent living with hepatitis C gives birth. The likelihood of vertical transmission increases to about 10% if the parent is living with both HIV and hepatitis C.

Although heterosexual transmission of hepatitis C is less common, the risk of sexual transmission is higher among individuals living with HIV, particularly among men who have sex with men (MSM). Factors such as having a sexually transmitted infection (STI), having multiple sexual partners, or engaging in sexual activities that may involve blood can increase the likelihood of hepatitis C transmission.

Transmission through shared glass pipes used for smoking stimulants, such as crack or methamphetamines, or through shared straws used for snorting substances, is less common but possible. This can occur if microscopic blood particles from a person living with hepatitis C are present on the pipe or straw and then enter another person’s bloodstream through sores, burns, or the delicate capillaries in the nasal passages.

Symptoms

In many cases, hepatitis C does not cause noticeable symptoms. In some cases, symptoms appear between two weeks to twelve weeks after exposure. Acute hepatitis is generally characterized by mild symptoms including nausea, vomiting, loss of appetite, joint pain, dark urine, and jaundice. Symptoms of chronic hepatitis C vary widely – some people may experience weight loss, brain fog, headaches, fatigue, depression or body aches, while others may experience no symptoms at all.

Testing

The only way to know if you have hepatitis C is by getting tested. An initial antibody test determines if a person has ever been exposed to hepatitis C. Antibodies are like the virus’s footprints–they indicate whether the virus has ever been in the body but not whether it is still present. Rapid antibody tests, test a small amount of blood from a fingerstick, provide results in about 20 minutes. Hepatitis C antibody testing is offered at community organizations, public health clinics, and other healthcare settings. If the rapid antibody test is reactive (detects the presence of hepatitis C antibodies), the person will be referred for a second test, that is known as a “viral load,” “PCR,” or “RNA” test. The second test confirms whether the virus is present in the body. At this time, a blood sample collected through phlebotomy is required for the confirmatory test. In June 2024, the U.S. Food & Drug Administration (FDA) approved a CLIA-waived, point-of-care (POC) RNA test that can determine a person’s hepatitis C status in 41 to 58 minutes using a capillary blood specimen. POC testing has the potential to reduce barriers to confirmatory testing and increase the number of people who know their status. Implementing POC testing in high-prevalence could support more people to link to care.

In 2021, California enacted AB 789, requiring that all adults be offered screening for hepatitis B and C at least once in their lifetime. Individuals at increased risk of hepatitis C exposures should discuss the need for periodic screening with their healthcare provider.

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Curative Treatment for Hepatitis C

Highly effective treatments can cure hepatitis C in most people within 8 to 12 weeks. These medications are generally well-tolerated, with mild or no side effects for most individuals.

In California, hepatitis C treatment is widely accessible and covered by programs such as Medi-Cal, Medicare, the AIDS Drug Assistance Program (ADAP), and the Veterans Administration. If you are living with hepatitis C, talk to your doctor or health care provider to explore treatment options and  start your journey toward a cure.