Hepatitis C Arkansas Department of Health

Hepatitis C

Hepatitis C is a contagious liver disease caused by the hepatitis C virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. It is usually spread when blood from a person who has hepatitis C enters the body of someone who is not infected. Many people experience mild or no symptoms at the time of infection, and patients may be infected for many years without being aware that they have the disease.

Hepatitis C can be either acute or chronic. Acute hepatitis C is a short-term illness that occurs within the first 6 months after someone is exposed to the virus. 55–85% of individuals with an acute infection will develop a chronic hepatitis C infection. Some acute infections will resolve on their own; however, if the infection is not cleared in the acute stage, it will progress to chronic hepatitis C. Chronic hepatitis C can cause long-term health problems such as cirrhosis, liver cancer, liver failure, or death.

There is no vaccine for hepatitis C, but there are effective methods to prevent being infected. The best way to prevent hepatitis C is by avoiding behaviors that can spread the disease, especially injection drug use, and to use precautions when exposed to blood. In addition, a blood test is available for hepatitis C screening.

Hepatitis C is treatable with a short course of direct-acting antiviral medication. Several of these drugs have been approved by the FDA in recent years. They can cure hepatitis C in over 90% of all cases and usually have few side effects

Risk Factors

What are the risk factors for hepatitis C?

You are at risk for hepatitis C if you:

Currently inject drugs
Injected drugs in the past, even if only one time or many years ago
Have been incarcerated
Received donated blood, blood products, or organs before 1992
Are a hemodialysis patient, or were previously on long-term hemodialysis
Have received body piercings or tattoos done with non-sterile instruments
Have known exposure to hepatitis C, such as
- Needlestick injuries among healthcare workers
- Other blood exposures among public safety workers
Have received blood or organs from a donor who tested positive for hepatitis C virus
Have HIV
Were born to a mother who had hepatitis C
Were born between 1945 and 1965
Have sexual contact with someone who has hepatitis C
Share personal care items, such as razors or toothbrushes, that may have come in contact with blood from someone who has hepatitis C

Hepatitis C is not spread by:

Sneezing
Coughing
Hugging
Holding hands
Kissing
Food or water
Sharing eating utensils

A person who has had other types of viral hepatitis, such as hepatitis A or hepatitis B, can still get hepatitis C.

What is the risk of a pregnant woman passing hepatitis C to her baby?

About 4%–8% of infants born to mothers with hepatitis C become infected with the virus. However, the risk is greater if the mother has both HIV and hepatitis C. Arkansas Act 598 of 2021 requires that healthcare providers in Arkansas must offer hepatitis C testing to all pregnant women.

Can you get hepatitis C from a mosquito or other insect bite?

No. The hepatitis C virus has not been shown to be transmitted by insects.

Can you have both hepatitis C and HIV at the same time?

Yes. Co-infection is common among people who inject drugs, though it can also occur in other groups.

Can you get hepatitis C more than once?

Yes. People who have had hepatitis C and have cleared the virus once may still be infected in the future with a different strain of the virus.

How long does the hepatitis C virus survive outside the body?

The hepatitis C virus can survive outside the body at room temperature, on environmental surfaces, for up to 3 weeks.

How should blood spills be cleaned from surfaces to make sure that the hepatitis C virus is gone?

Any blood spills — including dried blood, which can still be infectious — should be first cleaned using soap and water, and then disinfected using a dilution of one part household bleach to 10 parts water. Bleach solution should remain in contact with the surface for at least 10 minutes. Gloves should be worn when cleaning up blood spills.

Symptoms

What are the symptoms of acute hepatitis C?

Approximately 75–85% of people with acute hepatitis C do not have any symptoms. Some people, however, can have mild to severe symptoms soon after being infected, including:

Fever
Fatigue
Loss of appetite
Nausea
Vomiting
Stomach or abdominal pain
Dark urine
Clay-colored bowel movements
Joint pain
Jaundice (yellow color in the skin or eyes)

How soon after exposure to hepatitis C do symptoms appear?

If symptoms occur, the average time is somewhere between 2–12 weeks after exposure, but this can range from 2 weeks to 6 months. However, many people with hepatitis C do not develop acute symptoms.

Can you have hepatitis C and not know it?

Yes. Many people who have hepatitis C do not know they are infected because they do not look or feel sick.

Can you spread hepatitis C without having symptoms?

Yes. Hepatitis C can be spread by people who are not symptomatic.

What are the symptoms of chronic hepatitis C?

Most people with chronic hepatitis C do not have any symptoms and may remain symptom-free for many years. However, some common symptoms of liver damage, including from chronic hepatitis C, include:

Bleeding easily
Bruising easily
Fatigue
Poor appetite
Yellow discoloration of the skin and eyes (jaundice)
Dark-colored urine
Itchy skin
Fluid buildup in your abdomen (ascites)
Swelling in your legs
Weight loss
Confusion, drowsiness, and slurred speech (hepatic encephalopathy)
Spiderlike blood vessels on your skin (spider angiomas)

Screening/Testing

Who should get tested for hepatitis C?

Everyone should talk with their healthcare provider about hepatitis C testing.

You should be tested at least once if

You are an adult aged 18 or older. This applies to every adult, regardless of risk factors.
You are pregnant. Hepatitis C testing is recommended during every pregnancy.

You may need more frequent testing if

You are a current injection drug user
You are on long-term hemodialysis
You have abnormal liver tests or liver disease
You work in health care or public safety and were exposed to blood through a needlestick or other sharp object injury
You have HIV

What tests for hepatitis C are offered?

Screening for hepatitis C is available with a blood test for antibodies to the hepatitis C virus. This test shows if a person has ever been infected; however, it does not distinguish between recent and old infection. In addition, the test does not distinguish between persons who are infectious and those who have recovered and cannot pass the infection on to anyone else. If the antibody screening test is reactive, a confirmatory test for hepatitis C RNA will need to be done. The RNA test will distinguish between current active infections and infections that have resolved and are no longer infectious.

What do you do if your test for hepatitis C is positive?

Contact your healthcare provider. Your healthcare provider will be able to advise if additional testing is needed. If you are diagnosed with hepatitis C, they will also be able to offer advice about treatment and management of your condition.

Can you have normal liver enzyme (e.g., ALT) results and still have hepatitis C?

Yes. People with chronic hepatitis C may have a liver enzyme level that goes up and down. Some infected persons have liver enzyme levels that are normal for over a year even though they have chronic liver disease. If the liver enzyme level is normal, their healthcare provider may re-check several times over a 6–12 month period. If the liver enzyme level remains normal, it may be checked less frequently, such as once a year.

Treatment/Management

Is there medication for hepatitis C?

Yes. Hepatitis C is treatable with direct-acting antiviral medicines that can cure the disease in over 90% of all cases and usually have few side effects. Several new direct-acting antivirals have been approved for hepatitis C since 2013. If you have been diagnosed with hepatitis C, talk with your healthcare provider about treatment.

What else should you do to stay healthy?

In addition to treatment with direct-acting antivirals, there are several recommendations that most patients with hepatitis C should follow. They include:

Talk with your healthcare provider about HIV screening.
Get vaccinated against hepatitis A and hepatitis B.
Avoid consuming alcohol.
Talk with your healthcare provider before starting any new medications (prescription, over-the-counter, or supplements).

Your healthcare provider may also have advice that is specific to you about how best to manage your hepatitis C.

How do I find treatment and care for hepatitis C?

Talk with your primary care provider. If you need care from a specialist, your primary care provider will be able to provide a referral. If you are having difficulty finding a provider for hepatitis C care, you can also contact ADH’s Hepatitis C Program.

How can you avoid spreading hepatitis C?

If you have been diagnosed with hepatitis C:

Do not share anything that may become contaminated with blood. This includes needles, syringes, toothbrushes, razors, and other items.
Do not donate blood, plasma, other tissue, or sperm.
Cover open sores or other breaks in your skin.
Talk with your healthcare provider about safe sex practices.
Tell your sex partners that you have hepatitis C.
Tell your healthcare providers (including doctors, dentists, and others) that you have hepatitis C.

Can you donate blood or organs if you have hepatitis C?

The American Red Cross does not accept blood donations from people who have hepatitis C currently or have had hepatitis C in the past. However, patients with hepatitis C may be able to donate organs. Talk with your healthcare provider if you have been diagnosed with hepatitis C and are interested in organ donation.

Long-Term Effects

How serious is hepatitis C?

Without treatment, 55%–85% of all people who get hepatitis C never fully recover and can carry the virus for the rest of their lives. These persons have chronic hepatitis C, which can result in long-term health problems, including liver damage, liver failure, liver cancer, or death. Hepatitis C is a leading cause of cirrhosis (scarring of the liver), liver cancer, and liver transplantation in the United States. The Centers for Disease Control and Prevention (CDC) estimates that hepatitis C causes or contributes to over 10,000 deaths in the United States each year.

What are the long-term effects of hepatitis C?

Among patients with chronic hepatitis C who are not treated, approximately 20%–30% will develop cirrhosis. Among chronic hepatitis C patients with cirrhosis, approximately 1%–4% will develop hepatocellular carcinoma (liver cancer) each year, and approximately 2%–5% will develop end-stage liver disease each year. However, these rates are averages, and the prognosis for different patients may be very different.

Case Reporting (for healthcare providers)

How do you report hepatitis C to ADH?

Hepatitis C is a reportable disease in Arkansas. This means that healthcare providers and laboratories must report any hepatitis C diagnosis in an Arkansas resident to ADH. For information on how to report hepatitis C and other diseases to ADH electronically, refer to the Promoting Interoperability webpage. Electronic reporting via this method is strongly preferred. However, if your facility is not able to report hepatitis C electronically, you can complete the Communicable Disease Reporting Form and fax it to (501) 661-2428.