Hepatitis means inflammation of the liver. Acute hepatitis C virus (HCV) infection refers to the first six months after exposure. Up to 25% of people will clear the virus naturally without treatment. The rest will develop chronic, or long-term, infection.

Out of every 100 people with hepatitis C:

  • 75 to 85 will develop chronic HCV infection
  • 10 to 20 will develop cirrhosis over two or three decades.

Out of every 100 people with hep C and cirrhosis:

  • 1 to 5 will develop liver cancer each year
  • 3 to 6 will experience liver failure each year.

Many people with hepatitis C do not experience symptoms during its early stages—that is, they don’t feel or look sick. In fact, a majority of people living with HCV do not know they carry the virus. If they do occur, symptoms may include the following:

  • Fatigue, or extreme tiredness
  • Fever
  • Nausea
  • Loss of appetite
  • Unexplained weight loss
  • Abdominal discomfort
  • Muscle and joint aches
  • Jaundice, or yellowing of the skin and eyes
  • Dark-colored urine
  • Pale or clay-colored stools
  • Itchy skin
  • Edema, or swelling of the feet and lower legs
  • Brain fog, or problems with mental alertness and memory
  • Abnormal ALT and other liver enzyme levels.

Over years or decades, however, hep C can lead to serious complications. In the most severe cases, the liver can no longer carry out its vital functions, such as managing blood sugar and fat levels and filtering out toxins. An injured liver may develop scar tissue, known as fibrosis. Cirrhosis is the most advanced stage of fibrosis. Eventually, the buildup of scar tissue can block the flow of blood through the liver, causing portal hypertension.

HCV can cause hepatocellular carcinoma, the most common type of liver cancer. Untreated hep C can also lead to health problems beyond the liver, including an increased risk of lymphoma, heart disease and diabetes.

People with severe, or decompensated, cirrhosis may experience bloating due to the buildup of fluid in the abdomen (ascites), bleeding blood vessels (varices) in the esophagus or stomach and mental impairment (hepatic encephalopathy). In the most severe cases, they can develop life-threatening liver failure. Hep C is the most common reason for liver transplants in the United States.

Other causes of liver cirrhosis and liver cancer include hepatitis B virus (HBV), heavy alcohol use and fatty liver disease. Non-alcoholic fatty liver disease (NAFLD) and its more severe form, non-alcoholic steatohepatitis (NASH), are a growing cause of advanced liver disease. Now that HBV can be prevented with a vaccine and HCV can be easily treated, fatty liver disease is expected to overtake hep C as the leading reason for liver transplants.