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.
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.
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.
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.
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?