After exposure to the hepatitis C virus, it can take 8–11 weeks for an HCV antibody test to be reactive/positive. For most people who are infected, the HCV antibody blood test will become positive about 10 weeks after exposure. The test for hepatitis C virus, a special kind of blood test called a nucleic acid test (NAT) that detects HCV RNA (also called a PCR test) can tell if a person is infected within 1–2 weeks of exposure https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm.
Following initial infection, approximately 80% of people do not exhibit any symptoms (Spradling, P. 2024).
The most common symptoms of hepatitis C viral infection |
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Acute infection |
Chronic infection |
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People with acute HCV infection are usually asymptomatic or have mild symptoms. In those who develop symptoms, the average period from exposure to symptom onset is 2–12 weeks (range: 2–26 weeks) |
Most people with chronic HCV infection remain asymptomatic for decades or have non-specific symptoms such as chronic fatigue and depression. Most chronic infections are found with elevate alanine aminotransferase results during blood donation screening or on routine exams |
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• fever |
• loss of appetitie |
Many patients will develop chronic liver
disease, cirrhosis Extrahepatic manifestations of chronic HCV infection can include: Diabetes mellitus, Glomerulonephritis, Essential mixed cryoglobulinemia, Porphyria cutanea tarda, Non-Hodgkin’s lymphoma, peripheral edema, hepatic encephalopathy. |
| Source: https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm#b8 | ||
In very rare instances, fulminant hepatitis can occur, leading to rapid liver failure. However, the majority of cases are asymptomatic for many years.
The immune system spontaneously resolves HCV infection in about 15% to 25% of cases. Currently, more than a million Americans who were infected remain positive for HCV antibody but have no HCV circulating in their blood. Those with chronic HCV infection are at risk for chronic liver disease. Over time, up to 25% of those with chronic hepatitis develop a serious condition, such as cirrhosis or hepatocellular cancer. Cirrhosis greatly increases the risk of developing liver cancer.
Chronic hepatitis: About 80% of those infected with HCV will develop a chronic inflammation of the liver, called chronic persistent hepatitis. Hepatitis is defined as chronic if it persists past 6 months, and indeed it may persist for 30 years or more in people with chronic HCV infection.
Cirrhosis: Of every 100 people infected with HCV, approximately 5–25 will develop cirrhosis within 10–20 years. Patients who develop cirrhosis have a 1%–4% annual risk of developing hepatocellular carcinoma and a 3%–6% annual risk of hepatic decompensation; for the latter patients, the risk of death in the following year is 15%–20% (Thomas, 2005).
Factors affecting rates of HCV infection progressing to cirrhosis:
Alcohol effects: Alcohol consumption does not cause hepatitis C, but alcohol speeds the progression of hepatitis C and liver disease. There are no current guidelines as to how much alcohol might be safe to consume, but abstinence from alcohol is the safest course. Certainly heavy intake, more than 3 drinks per day, should always be avoided, and people should remain abstinent throughout anti-viral treatment. Another problem related to alcohol consumption is that antiviral therapy may be ineffective. Also, interferon therapy can be associated with relapse in people with history of alcohol abuse. Interferon therapy should be used with caution in those who recently stopped alcohol abuse, and these patients should be referred to alcohol abuse treatment programs for support during anti-viral treatment.
There are a number of risk factors associated with HCV and the development of HCC.
The mechanism by which HCV causes HCC is not well-understood. Since HCC is highly correlated with cirrhosis, some suggest that HCV is a secondary cause; however, some HCV patients have HCC without underlying cirrhosis. It is believed that the core protein of HCV impedes the natural process of cell death or interferes with the function of a normal inhibitor (tumor suppressor) gene. Thus, the liver cells live and reproduce without normal constraints, resulting in cancer. Commonly, an individual with alcohol-induced cirrhosis has stopped drinking for about 10 years prior to a diagnosis of HCC; actively drinking alcoholics rarely develop HCC. It appears that when the alcoholic stops drinking, the liver cells attempt to regenerate, and during this regeneration, mutations occur.
Cryoglobulinemia:
About 5% of HCV patients develop a combination of joint pain, weakness,
and areas of bleeding into the skin known as cryoglobulinemia. The kidneys
and brain also may be affected.
Psychiatric co-morbidity:
Studies have shown that patients with HCV have a higher prevalence of psychiatric
illness, and patients with severe mental illness have 4 to 9 times the
prevalence of HCV. Interferon treatment has been associated with frequent
adverse affects: affective, anxiety, cognitive, and psychotic symptoms.
Psychiatric symptoms often results in interruption or cessation of treatment,
so pretreatment assessment and ongoing psychiatric follow-up is critical.
A study at a Veteran's Affairs Medical Center showed that of 306 randomly selected HCV patients, a large percentage had psychiatric disorders:
References
CDC (2023). Hepatitis C Questions and Answers for Health Professionals. accessed 3/31/2024 from https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm#b8
Liang, T.J., Rehermann, B., Seeff, L.B., Hoofnagle, J.H. (2000) Pathogenesis, natural history, treatment, and prevention of hepatitis C. Ann Intern Med.;132(4):296-305.
Spradling, P. (2023) CDC. Hepatitis C CDC Yellow Book 2024. Clinical Presentation. Accessed 3/31/2024, from https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/hepatitis-c#clinical
Thomas, D.L., Seeff, L.B.(2005) Natural history of hepatitis C. Clin Liver Dis.;9(3):383-98
Who.int. 2021. Hepatitis C. [online] Available at: https://www.who.int/news-room/fact-sheets/detail/hepatitis
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