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Why Hepatitis C is Called a "Quiet Killer"

Most people with hepatitis C have no symptoms until the disease has caused serious liver damage. Here’s what you need to know about hep C diagnosis.

Why Hepatitis C is Called a "Quiet Killer"

Medically reviewed in December 2020

Here’s the thing about the symptoms of hepatitis C: There usually aren’t any. Many people who have the virus—which causes inflammation that can destroy the liver or even cause cancer—don’t know they’re infected for 20, 30 years or more. All that time, the virus slowly, quietly attacks its host, only becoming known once it’s caused serious, permanent damage.

But that’s getting ahead. Let’s back up for a minute and talk about how hep C progresses, and how it’s detected.

Warning signs of a new infection
In nearly all cases, people get hep C by contacting the blood of an infected person—such as through a contaminated needle, tattoo or piercing instrument, or much less commonly, during sex. About one to three months later, 20 to 30 percent of people develop flu-like symptoms, as the virus tries to establish itself in the body and the immune system fights it. Those symptoms are usually mild and vague, and it can be easy to confuse them with other problems. They can include:

  • Fever
  • Fatigue
  • Poor appetite
  • Upset stomach
  • Abdominal pain
  • Muscle or joint pains
  • Jaundice (yellow skin and eyes)
  • Dark-colored urine

These symptoms may last up to six months. In some people, the immune system wins the battle and clears the infection completely. However, for 75 to 85 percent, the virus persists, and the disease becomes chronic.

Hep C complications
Chronic hep C usually lasts a lifetime. In this phase, the virus goes silent, usually causing no symptoms at all, though people can still transmit it to others. If the disease is detected, it’s often by accident, when routine blood tests happen to find changes in liver function. However, even those liver tests may be normal at times.

Without treatment, after 20 to 30 years, people may develop cirrhosis (scarring) of the liver—a type of damage that's irreversible. Cirrhosis can cause weakness, fatigue, itching skin and weight loss. As the liver fails, people may notice that they bleed or bruise easily, have swelling in their legs or abdomen and have spider-like blood vessels on their skin. They may also have jaundice and be more sensitive to medications, or could develop diabetes.

In very severe cases, people may have mental problems, such as confusion, trouble concentrating, memory loss and personality changes. They can become difficult to wake, or even fall into a coma.

Should you be tested?
Because these serious problems are often the first sign of the disease, people who are at risk shouldn’t hope for a lucky diagnosis or wait until they feel sick to get tested. Doctors can detect the virus with simple blood tests. The U.S. Preventive Services Task Force recommends hep C screening for all people between the ages of 18 and 79 years.

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