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Hcv signs and symptoms: Hepatitis C – Diagnosis and treatment

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Hepatitis C – Diagnosis and treatment

Diagnosis

Screening for hepatitis C

The U.S. Preventive Services Task Force recommends that all adults ages 18 to 79 years be screened for hepatitis C, even those without symptoms or known liver disease. Screening for HCV is especially important if you’re at high risk of exposure, including:

  • Anyone who has ever injected or inhaled illicit drugs
  • Anyone who has abnormal liver function test results with no identified cause
  • Babies born to mothers with hepatitis C
  • Health care and emergency workers who have been exposed to blood or accidental needle sticks
  • People with hemophilia who were treated with clotting factors before 1987
  • People who have undergone long-term hemodialysis treatments
  • People who received blood transfusions or organ transplants before 1992
  • Sexual partners of anyone diagnosed with hepatitis C infection
  • People with HIV infection
  • Anyone born from 1945 to 1965
  • Anyone who has been in prison

Other blood tests

If an initial blood test shows that you have hepatitis C, additional blood tests will:

  • Measure the quantity of the hepatitis C virus in your blood (viral load)
  • Identify the genotype of the virus

Tests for liver damage

Doctors typically use one or more of the following tests to assess liver damage in chronic hepatitis C.

  • Magnetic resonance elastography (MRE). A noninvasive alternative to a liver biopsy (see below), MRE combines magnetic resonance imaging technology with patterns formed by sound waves bouncing off the liver to create a visual map showing gradients of stiffness throughout the liver. Stiff liver tissue indicates the presence of scarring of the liver (fibrosis) as a result of chronic hepatitis C.
  • Transient elastography. Another noninvasive test, transient elastography is a type of ultrasound that transmits vibrations into the liver and measures the speed of their dispersal through liver tissue to estimate its stiffness.
  • Liver biopsy. Typically done using ultrasound guidance, this test involves inserting a thin needle through the abdominal wall to remove a small sample of liver tissue for laboratory testing.
  • Blood tests. A series of blood tests can indicate the extent of fibrosis in your liver.

Transient elastography

A member of the care team performs transient elastography — a painless alternative to liver biopsy — to assess liver damage.

Treatment

Antiviral medications

Hepatitis C infection is treated with antiviral medications intended to clear the virus from your body. The goal of treatment is to have no hepatitis C virus detected in your body at least 12 weeks after you complete treatment.

Researchers have recently made significant advances in treatment for hepatitis C using new, “direct-acting” antiviral medications, sometimes in combination with existing ones. As a result, people experience better outcomes, fewer side effects and shorter treatment times — some as short as eight weeks. The choice of medications and length of treatment depend on the hepatitis C genotype, presence of existing liver damage, other medical conditions and prior treatments.

Due to the pace of research, recommendations for medications and treatment regimens are changing rapidly. It is therefore best to discuss your treatment options with a specialist.

Throughout treatment your care team will monitor your response to medications.

Liver transplantation

If you have developed serious complications from chronic hepatitis C infection, liver transplantation may be an option. During liver transplantation, the surgeon removes your damaged liver and replaces it with a healthy liver. Most transplanted livers come from deceased donors, though a small number come from living donors who donate a portion of their livers.

In most cases, a liver transplant alone doesn’t cure hepatitis C. The infection is likely to return, requiring treatment with antiviral medication to prevent damage to the transplanted liver. Several studies have demonstrated that new, direct-acting antiviral medication regimens are effective at curing post-transplant hepatitis C. At the same time, treatment with direct-acting antivirals can be achieved in appropriately selected patients before liver transplantation.

Vaccinations

Although there is no vaccine for hepatitis C, your doctor will likely recommend that you receive vaccines against the hepatitis A and B viruses. These are separate viruses that also can cause liver damage and complicate the course of chronic hepatitis C.

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Clinical trials


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Lifestyle and home remedies

If you receive a diagnosis of hepatitis C, your doctor will likely recommend certain lifestyle changes. These measures will help keep you healthy longer and protect the health of others as well:

  • Stop drinking alcohol. Alcohol speeds the progression of liver disease.
  • Avoid medications that may cause liver damage. Review your medications with your doctor, including over-the-counter medications you take as well as herbal preparations and dietary supplements. Your doctor may recommend avoiding certain medications.
  • Help prevent others from coming in contact with your blood. Cover any wounds you have and don’t share razors or toothbrushes. Don’t donate blood, body organs or semen, and advise health care workers that you have the virus. Also tell your partner about your infection before you have sex, and always use condoms during intercourse.

Preparing for your appointment

If you think you may have a risk of hepatitis C, see your family doctor. Once you’ve been diagnosed with a hepatitis C infection, your doctor may refer you to a specialist in liver diseases (hepatologist) or infectious diseases.

What you can do

Because appointments can be brief and because there’s often a lot to discuss, it’s a good idea to be well prepared. To prepare, try to:

  • Review your medical record. This is particularly important if you are seeing a liver specialist (hepatologist) for the first time after finding out you have hepatitis C. If you had a liver biopsy to check for damage from chronic infection and a blood test to determine which hepatitis C genotype you have, make sure you know the results so you can share them with your specialty care team.
  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there’s anything you need to do in advance, such as restrict your diet.
  • Write down any symptoms you’re experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Make a list of all medications, vitamins or supplements you’re taking.
  • Consider taking a family member or friend. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.

To make the most of your time with your doctor, take along a list of questions you want to ask. Put your most important questions at the top of your list, in case time runs out. For a hepatitis C infection, some basic questions to ask your doctor include:

  • Should I be tested for other causes of liver disease, such as hepatitis B?
  • Has the hepatitis C virus damaged my liver?
  • Do I need treatment for a hepatitis C infection?
  • What are my treatment options?
  • What are the benefits of each treatment option?
  • What are the potential risks of each treatment option?
  • Is there one treatment you think is best for me?
  • I have other medical conditions. How will these affect my hepatitis C treatment?
  • Should my family be tested for hepatitis C?
  • Is it possible for me to spread the hepatitis C virus to others?
  • How can I protect the people around me from hepatitis C?
  • Should I see a specialist? Will my insurance cover it?
  • Are there brochures or other material that I can take with me? What websites do you recommend?
  • What will determine whether I should plan for a follow-up visit?
  • Is it safe for me to drink alcohol?
  • What medications should I avoid?

Don’t hesitate to ask any other questions that occur to you during your appointment.

What to expect from your doctor

Your doctor is likely to ask you some of the following questions. If you’ve thought about your answers beforehand, this part of the visit may go more quickly than usual, leaving you more time to address your concerns.

  • Have you ever had a blood transfusion or an organ transplant? If so, when?
  • Have you ever used self-injected drugs not prescribed by your doctor?
  • Have you ever been diagnosed with hepatitis or jaundice?
  • Does anyone in your family have hepatitis C?
  • Is there a history of liver disease in your family?

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Hepatitis C: How common is sexual transmission?

Hepatitis C is transmitted primarily by exposure to blood containing the hepatitis C virus. Current research suggests that if you’re in a long-term, monogamous relationship with a partner who has hepatitis C, your risk of contracting hepatitis C is quite low — unless you also have human immunodeficiency virus (HIV).

For monogamous couples, the Centers for Disease Control and Prevention (CDC) doesn’t recommend routine condom use to prevent hepatitis C transmission. But couples should avoid sharing razors, toothbrushes and nail clippers. Your risk may also be higher if you have intercourse during menstruation or have anal sex, which is more likely to cause bleeding.

Your risk of contracting hepatitis C increases significantly if you have HIV. Also, the risk of transmission is higher if you have multiple short-term sexual relationships with partners who have hepatitis C. Under these circumstances, the CDC recommends routine condom use to reduce your risk of transmission.

If you’re concerned about hepatitis C, talk to your doctor. Hepatitis C can be diagnosed by a simple blood test. Treatment may include medications to help clear the virus from the bloodstream and ultimately cure you of hepatitis C.

With

Stacey A. Rizza, M.D.

  • Hepatitis C: What happens in end-stage liver disease?

Nov. 08, 2019

Show references

  1. Emerging issues, hepatitis C: Sexually transmitted diseases treatment guidelines, 2015. Centers for Disease Control and Prevention. https://www.cdc.gov/std/tg2015/emerging.htm. Accessed Oct. 18, 2019.
  2. Hepatitis C. NHS. https://www.nhs.uk/conditions/hepatitis-c/. Accessed Oct. 18, 2019.
  3. Hepatitis C questions and answers for health professionals. Centers for Disease Control and Prevention. https://www.cdc.gov/hepatitis/HCV/HCVfaq.htm. Accessed Oct. 21, 2019.
  4. Bennett JE, et al., eds. Hepatitis C. In: Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, Pa.: Elsevier; 2020. https://www.clinicalkey.com. Accessed Oct. 18, 2019.

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Hepatitis C Virus: Signs, Symptoms, and Complications

The signs and symptoms of hepatitis C virus infection (HCV) vary based on the stage of infection.  The most common symptoms include fatigue, jaundice, (yellow coloring of the skin and eyes), fever, and nausea. In advanced stages of the infection, liver failure may cause bleeding problems or encephalopathy (severe confusion). Sometimes liver cancer may develop, often manifesting as a malnourished appearance.

Illustration by Verywell

Stages of Illness

The impact of HCV in the body changes over time after the initial infection. This is largely due to the proliferation of the virus, which can reproduce inside the body, making numerous copies of itself. The progression also has to do with the cumulative effect of the virus on the liver. 

The stages of HCV infection:

  • Incubation period: During this stage, you could have been infected with the virus, but you most likely will not have any symptoms. If you do have symptoms, they may include fever, fatigue, or stomach upset.
  • Acute Hepatitis: About two to 12 months after the virus invades the body, HCV can cause mild to moderate illness.  Symptoms of acute infection are seen in about 15 to 20 percent of people who have been exposed to the virus. Presentation is often flu-like, with little evidence of liver injury. About one in four people successfully fight off the virus during this stage.
  • Chronic Hepatitis: The majority of those infected with HCV go on to have chronic hepatitis. Chronic infection occurs when the hepatitis C virus (HCV) does not spontaneously clear and remains in the body. Some people develop symptoms of chronic infection years after being infected with the virus, without ever having had acute hepatitis symptoms. 
  • End Stage Hepatitis: A more complicated form of the disease manifests with liver failure and a number of serious complications, which can include kidney failure and liver cancer. 

Frequent Symptoms

The symptoms of liver failure include generalized flu-like symptoms, as well as more specific signs of liver involvement because the virus targets the liver.  Common symptoms that occur in both the acute and chronic phase of HCV infection generally last longer and are more severe during the chronic stage of the infection.  

The most common symptoms of HCV include symptoms that are not specific to hepatitis and occur with most infections. These symptoms are largely due to the activity of the body’s own immune system as it fights the virus.

The most common symptoms of acute and chronic HCV include:

  • Fatigue
  • Fever
  • Jaundice
  • Nausea and vomiting
  • Decreased appetite
  • Abdominal pain 
  • Diarrhea
  • Joint pain
  • Muscle Pain

Some of the symptoms of acute and chronic stage HCV are similar to the symptoms of any liver disease.

  • Bleeding and Bruising: The liver plays a role in producing proteins that aid in blood clotting, which is part of healing from an injury. Bleeding and bruising can be signs of liver dysfunction, resulting from the viral attack on the liver, as well as the body’s inflammatory response to the virus.  
  • Dark-colored urine: The build-up of bilirubin, which is produced when the liver is infected or impaired, can cause jaundice, as well as the dark coloring of the urine (choluria), and pale or chalky stools.
  • Pale or chalky stools

In acute hepatitis, these symptoms typically resolve on their own, although more severe cases involving jaundice and choluria may take up to a year. In chronic hepatitis, these symptoms are generally more persistent than they are in acute hepatitis. 

Rare Symptoms

A number of less common symptoms of HCV infection can occur during the acute or chronic stages. Many of these symptoms result from liver dysfunction or from the body’s inflammatory response to the virus. 

  • Weight Loss: This may occur due to a number of effects of HCV infection. Nausea, vomiting, and fatigue can diminish your appetite, causing you to reduce the amount of food you want to eat. And, as the liver becomes impaired, it may not produce several important proteins and fats that help you digest and absorb the food you eat, leading to diarrhea and basically, malnutrition even when you eat.  
  • Abnormal tingling or burning sensations
  • An uncomfortable “pins and needles” sensation
  • Itchy skin
  • Raised, bumpy areas of rash
  • Dry eyes accompanied by dry mouth
  • Rheumatic diseases: Joint swelling and muscle aches and pains can begin before you know that you have been exposed to HCV and may also occur at any stage of the infection. The joint and muscle pains are due to the fact that the immune system is stimulated continuously to fight the virus.
  • Vasculitis (inflammation of the blood vessels) rarely occurs and may cause a range of effects, including pain, blood clots, and even strokes or heart attacks, although this is rare. 
  • Cryoglobulinemia: Cryoglobulins are proteins within the blood that get solidified when exposed to cold temperatures, causing problems with circulation. 

Complications

The chronic stage of hepatitis C can persist for decades. During this time, steatosis (chronic build-up of fats) and fibrosis (progressive scarring of tissue) can cause damage to the liver. Both of the conditions often develop silently, with most people experiencing little or no signs of illness.

End-stage liver disease refers to the point where the liver has been severely damaged and is unable to function. Symptoms are usually highly evident at this stage, often affecting multiple organ systems, including the brain, kidney, and upper digestive tract. 

Among people with chronic hepatitis C infection, 10 to 15 percent will advance an irreversible condition called cirrhosis, in which the damage caused by fibrosis is so extensive that the blood flow in and out of the liver is altered.

Cirrhosis is staged by the degree of impairment and classified as either:

  • Compensated cirrhosis
  • Decompensated cirrhosis

Compensated cirrhosis means that the liver is functioning relatively well and, as such, may cause minimal symptoms. When present, symptoms can include complications involving the skin, muscles, and joints as the constricted blood supply triggers both an increase in localized blood pressure, known as portal hypertension and a build-up of bile and other toxins.  

Among the possible symptoms of compensated cirrhosis:

  • Spider veins, mainly on the trunk and face
  • Itchy skin
  • Redness on the palms of the hands
  • Easy bruising or abnormal bleeding
  • The build-up of fluid in the ankles and feet
  • Poor concentration and memory
  • Loss of appetite
  • Weight loss
  • Shrinking testicles
  • Erectile dysfunction or loss of libido
  • Alcohol intolerance

The end stage complications of hepatitis C infection include:

  • Decompensated cirrhosis
  • Hepatocellular carcinoma (HCC)
  • End-stage renal disease (ESRD)

Decompensated cirrhosis is a serious condition in which the progressive scarring of the liver has left it severely damaged and unable to function. Symptoms are often profuse and progressive and can present in a number of ways, including:

  • Persistent fatigue
  • Jaundice
  • Tarry or bloody stools
  • The build-up of fluid in the abdominal cavity, causing swelling and distention
  • A distinct “sweet-musty” to “rotten egg” breath odor
  • Extreme bruising or bleeding
  • Abnormally decreased urine output
  • Personality changes, confusion, or tremors
  • Increased sleepiness
  • Muscle wasting
  • White discoloration or “milk spots” on the nails
  • Vomiting of blood
  • Esophageal varices (expanded blood vessels of the esophagus that may bleed)

Hepatocellular carcinoma (HCC) is a type of liver cancer that develops almost exclusively in association with cirrhosis in people with hepatitis C.  The symptoms of HCC are similar to those of decompensated cirrhosis and can include:

  • Persistent fatigue
  • Jaundice
  • The build-up of fluid in the abdominal cavity
  • Abnormal bruising and bleeding
  • Unintentional, extreme weight loss
  • Loss of appetite
  • Feeling full after eating a small amount
  • Delirium, confusion, or coarse “jerking” muscle movements
  • Abdominal discomfort, particularly in the upper right quadrant below or just under the ribs

End-stage renal disease (ESRD), which is advanced kidney failure, can both be caused and complicated by hepatitis C infection. The symptoms of ESRD vary and include:

  • Persistent fatigue
  • Chronic abdominal pain
  • Abnormally decreased urine output
  • Inability to urinate
  • Urine breath odor
  • Mottled or uneven, patchy skin discoloration
  • Muscle wasting
  • Swelling of the legs and feet, or around the eyes
  • Nausea or vomiting, particularly in the morning and after meals
  • Increased sleepiness
  • Repetitive twitchiness of the legs
  • Shortness of breath or difficulty breathing
  • Mental impairment, confusion

Outcomes of end-stage liver disease are generally poor, with a five-year survival rate of 50 percent in persons with decompensated cirrhosis and 30 percent in those with HCC.

When to See the Doctor

Because the symptoms of HCV may not occur in early stages, and because they are not always terribly alarming, even in the acute and chronic stages, you may need to see a doctor even if you do not have obvious symptoms of the infection.

Signs of Exposure

You should see your doctor if you have been exposed to the virus, either recently or at any time in the past. If you experienced any of the following, you might have been exposed to HCV: 

  • If you have had unprotected sex with someone who has or who could have HCV
  • If you have shared needles with anyone
  • If you have had a cut or a break in your skin from a needle, glass, or any other object that was or could have been contaminated with HCV infected blood
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If you develop symptoms of liver failure or severe infection, you should also see your doctor, as the cause could be HCV or another serious condition that also requires medical attention. Signs and symptoms to look out for include:

  • Persistent fevers
  • Jaundice
  • Change in the color of your urine
  • Nausea, vomiting or diarrhea that is excessive or lasting for longer than a week 
  • Unexplained fatigue lasting longer than a week
  • Swelling of your abdomen

Frequently Asked Questions

How long is the hepatitis C incubation period prior to showing symptoms?

Some people who contract hepatitis C never show symptoms and it is possible to transmit this disease to someone else without showing symptoms. For people who do show symptoms, they typically appear two to 12 weeks after exposure. Symptoms of liver disease or failure can then show up years later.

Can hepatitis C be cured?

Yes, the use of antiviral medication, specifically direct-acting antivirals, has been shown to cure more than 95% of hepatitis C cases.

Hepatitis C Symptoms & Treatment in Children

What Is Hepatitis C?

Hepatitis C is a liver disease caused by the hepatitis C virus, which is carried in the blood of infected people. According to various estimates, there are anywhere from approximately 3 to 10 million people in the United States who are carriers of the virus. One reason for the uncertainty is that the virus wasn’t even diagnosed until the late 1980s. In fact, a majority of hepatitis C virus carriers are still unaware that they have it.

As compared to adults, knowledge of hepatitis C virus infection in children is limited. This is because far fewer children are infected with hepatitis C virus, and children are less likely to have symptoms from their hepatitis C virus infection. Clinical liver disease due to hepatitis C virus is extremely rare in childhood. The exceptions are mainly children with other risk factors (other viruses, chemotherapy, immunosuppression).

The disease is serious for some people, but not for others. Most people who get hepatitis C carry the virus for the rest of their lives. The majority will experience some liver damage, but may not feel sick from the disease. Some people with liver damage due to hepatitis C may develop cirrhosis (scarring) of the liver and liver failure, which may take many years to develop.

Hepatitis C is primarily spread through contact with infected blood. The virus can be passed on by injecting drugs with shared needles; receiving a tattoo, body piercing, or acupuncture with unsterilized equipment; or less commonly through sexual contact. Children are more likely to contract hepatitis C virus through:

  • Being born to a mother who is infected with hepatitis C virus
  • Receiving hepatitis C virus-infected blood transfusions (before 1992) or blood clotting products (before 1987)
  • Receiving an hepatitis C virus-infected organ transplant
  • Receiving long-term kidney dialysis treatment (dialysis machine can be tainted with hepatitis C virus-infected blood)
  • Sharing personal hygiene items (such as toothbrushes, razors, or nail-clippers) that have hepatitis C virus-infected blood on them

It is important to remember that the hepatitis C virus can not spread through:

  • The air
  • Unbroken skin
  • Casual social contact
  • Breast-feeding

Hepatitis C Symptoms in Infants and Children

Although the hepatitis C virus can be detected in blood between one to three weeks after the initial exposure, 80 percent of people with hepatitis C have no symptoms, and thus go undiagnosed. , Most patients begin to develop liver cell injury within approximately 50 days, although they will be asymptomatic (symptom-free). In about 15 percent of people exposed to the virus, their bodies clear it out of their system naturally within six months. The remaining 85 percent of people with hepatitis C will develop some level of chronic hepatitis C. Over time, this can cause serious liver damage, although the rate of progression can vary significantly from individual to individual. Hepatitis C symptoms may include:

  • Fatigue
  • Loss of appetite
  • Jaundice (yellowing of the eyes and skin)
  • Darker colored urine
  • Abdominal pain
  • Aches and pains
  • Itching
  • Hives
  • Joint pain
  • Loose, light-colored stools
  • Nausea
  • Vomiting

Serious complications of hepatitis C infection include:

  • The possibility that the infection will become chronic, leading to progressive liver failure
  • Increased risk of hepatocellular carcinoma (liver cancer)
  • Cirrhosis – Within about 20 years of exposure, about 20 percent of individuals develop cirrhosis, which leads to end-stage liver disease.

Hepatitis C Diagnosis

To diagnosis hepatitis C, your child’s doctor will ask about symptoms, medical history, and perform a physical exam. Your doctor will also want to discuss your child’s risk factors for hepatitis C. Tests that may be conducted include:

  • Blood Tests – to look for hepatitis C antibodies or genetic material from the virus (The antibodies are proteins that your body has made to fight the hepatitis C virus.)
  • Liver Biopsy – removal of a sample of liver tissue to be examined

Hepatitis C Treatment

Hepatitis C treatment includes medications. The most common are:

  • Interferon, given by injection
  • Ribavirin, given orally
  • A combination of interferon and ribavirin

The course of this type of treatment is usually over a period of months. These medications can cause side effects that resemble the symptoms of hepatitis C itself, only magnified. However, these antiviral treatments can dramatically reduce the presence of the hepatitis C virus in the bloodstream. The limited studies available on the effectiveness of antiviral treatments on children show that they have an overall better response rate to this therapy than adults.

Even with treatment, hepatitis C infection may not clear up within six months. In rare cases, a liver transplant may be needed. However, it is possible that hepatitis C can affect the new liver after transplantation.

Learn about other Liver Disease States.

Signs and Symptoms of Hepatitis C

Even when an acute infection becomes chronic, it can be years before a person receives a diagnosis, thus delaying treatment. In fact, the majority of people with chronic hepatitis C are asymptomatic until the liver becomes severely damaged, often decades after exposure, says Dr. Adalja. (2)

It’s common for people to unknowingly carry HCV until they go through a blood screening or other examination for reasons unrelated to hepatitis C. (1)

However, chronic hepatitis C is a serious issue that can result in long-term health problems, including liver damage, liver cancer, liver failure, and death. (4)

According to the CDC, approximately 10 to 20 percent of people with chronic hepatitis C develop cirrhosis (an irreversible scarring of the liver that prevents the organ from functioning normally) over a period of two to three decades. (1)

People with cirrhosis have a 1 to 5 percent annual risk of developing liver cancer and a 3 to 6 percent risk of hepatic decompensation (the development of serious, life-threatening liver-related problems). There’s a 15 to 20 percent risk of death in the year following the development of decompensation. (1)

Age and gender have been shown to affect how chronic hepatitis C progresses, warns Adalja. It doesn’t advance to cirrhosis and liver cancer as quickly in premenopausal women as it does in men, according to a report published in July 2013 in Southern Medical Journal. (6)

Adalja notes that other factors that may accelerate chronic hepatitis C progression, increasing the risk of liver damage. These include HIV or hepatitis B coinfection, alcohol overuse, and cigarette smoking. (7) The symptoms of chronic hepatitis C vary depending on the type of liver damage.

Cirrhosis can produce a variety of symptoms: (8)

  • Itchiness
  • Fatigue
  • Abdominal bloating from a buildup of fluids
  • Swelling (also due to a buildup of fluids) in the feet, ankles, or legs
  • Spider angiomas (small red spots of dilated blood vessels)

Hepatitis C Signs and Symptoms

You can live with hepatitis C, a viral infection transmitted through blood, for decades unaware and without symptoms—until you’re met with undeniable proof that something is very wrong. It’s crucial to not to dismiss any early signs and to ask your doctor for testing if you suspect you’ve been exposed to hep C. Some reassuring news: With treatment, hep C is curable.

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