Patient information from BMJ

Hepatitis C: what is it?

Last published:Jan 30, 2023

Hepatitis C is an infection that can harm your liver. Many people don't know they have it, because you can have it for many years without any symptoms. If you have hepatitis C you'll want to know what that means for you.

This leaflet gives you basic information about the infection and what might happen. 

What is hepatitis C?

Hepatitis C is an infection caused by a virus that is carried in human blood. You can catch it if blood from someone with the virus gets into your bloodstream.

In many people the body fights off the virus naturally, without any treatment. This happens for between 15 and 45 in every 100 people infected with the virus.

But many people aren't able to fight off the infection on their own. If you have had the infection for more than six months doctors say you have chronic hepatitis C (chronic means long-lasting). 

There are six types of hepatitis C virus. They have different genes. Doctors call the types genotypes, and they are numbered 1 to 6.

Most people with hepatitis C in Western Europe have genotype 1, 2, or 3. You will have a blood test to find out what type you have.

Ask your doctor: what genotype of hepatitis C do I have?

How did I get hepatitis C?

It can be a shock to find out that you have hepatitis C. You may wonder how you caught the virus. Some people never find out how it happened.

• Most people who have hepatitis C got the virus by sharing needles to inject illegal drugs.

• Before 1991 some people were also infected through blood transfusions. Since then, blood that's used for transfusions has been screened for hepatitis C.

• Sometimes doctors and nurses get hepatitis C by being accidentally poked by an infected needle (for example, when giving injections to patients with hepatitis C).

• Some babies are born with hepatitis C because their mothers have the virus.

• There is a small chance that you can get hepatitis C if you have sex with someone who is infected and you don't use a condom (unprotected sex).

• You can get it from sharing toothbrushes or razors with someone who is infected.

You can't catch hepatitis by kissing, cuddling, or holding hands. And you can't get it by sharing household items like plates or knives and forks.

Ask your doctor: how can I avoid passing hepatitis C to anyone else?

What are the symptoms?

People who are infected with hepatitis C might get mild symptoms, such as feeling tired, or they might not get any symptoms at all. And the symptoms can come and go.

Many people who have hepatitis C don't get any symptoms for many years. And they may not get all of them. 

These are the main symptoms of hepatitis C. You are more likely to get them if you've had hepatitis C for a long time and it has affected your liver. These symptoms are:

• yellow colour to your skin and the whites of your eyes. This is called jaundice

• tiredness

• dark-coloured urine

• pain in the upper right side of your abdomen

• losing your appetite and losing weight

• feeling sick.

If the hepatitis C virus keeps damaging your liver over a long time you might get more serious symptoms.

Up to 20 in every 100 people who are infected with hepatitis C eventually get scarring in their liver (cirrhosis) if they don't have treatment. Cirrhosis tends to get worse over time. And it can stop your liver working properly. 

The symptoms of cirrhosis include:

• a swollen liver, which may make your abdomen feel sore and bloated

• weak muscles

• swollen ankles

• bloating in your abdomen

• itchy skin.

Ask your doctor: what should I do if I start getting symptoms, or my symptoms get worse?

How is hepatitis C diagnosed?

If you are concerned that you might have hepatitis C your doctor will ask you questions to see if you are at risk and examine you for any signs of liver damage.

Your doctor might also check you for hepatitis C if a routine blood test suggests your liver isn't working as well as it should.

The only way to find out for sure whether you have hepatitis C is to have a blood test for the virus. If your blood test is positive, that means you have the virus in your blood. But the test doesn't tell you if the virus has affected your liver or how long you have had it for.

If you have the virus your doctor will do additional blood tests to see if your liver has been affected. These are sometimes called liver function tests. You might also hear them called an alanine aminotransferase test (ALT test for short) and an aspartate aminotransferase test (AST test for short).

Your doctor may also suggest that you have a small piece of your liver taken out and checked under a microscope. This is called a liver biopsy. It will show if the virus has damaged your liver.

The results may help you decide whether to have treatment straight away, or whether to wait and see what happens to your liver. 

Ask your doctor: what tests might I need?

What can I do to stay healthy?

If you have hepatitis C you can do some things to try to keep your liver as healthy as possible.

You should avoid drinking alcohol. Even small amounts of alcohol might harm your liver.

You don't need to eat in a special way. But try to keep to a healthy weight. You should eat sensibly and stick to healthy foods. And you should take regular exercise.

Your doctor might recommend that you have vaccines to protect you from the hepatitis A and hepatitis B viruses. If you are infected with these viruses as well as hepatitis C this can speed up the damage to your liver.

Ask your doctor: should I have the hepatitis A and B vaccines?

What will happen to me?

Among people with the most common genotypes (1, 2, and 3), those with genotype 1 used to have a much smaller chance of getting rid of the virus through treatment than people with genotype 2 or 3.

But newer treatments have changed this. Now, most people have no sign of the virus six months after they finish treatment. 

It's hard to say what will happen to you if you don't have treatment. Many people live with the hepatitis C virus in their bodies for many years and don't have any health problems. But other people get liver damage (cirrhosis).

Cirrhosis can cause serious problems with your liver, including liver cancer. If these things happen to you, you might need a liver transplant.

It's a big operation, and donated livers aren't always available. But it can save your life if your liver is badly damaged. 

If you are interested in learning more about medicines to treat hepatitis C, see our information on Hepatitis C: what treatments work.