But for all that good news, there are some worrisome trends developing with hepatitis C. The opioid crisis has fueled a continued growth in the number of new cases among young adults, with year-over-year increases of around 14 percent, according to the latest figures from the Centers for Disease Control and Prevention (CDC). Meanwhile, the number of people in the U.S. seeking treatment for hepatitis C has fallen for the last five years, possibly due to stigma and insurance hurdles in certain communities, according to a 2021 CDC report. So how many people in the U.S. have hepatitis C? A study in the journal Hepatology puts the numbers anywhere between 2.5 and 4.7 million—the large spread necessitated by the fact that people in the early stage of chronic hepatitis C do not have symptoms, so diagnosis is difficult. By the time signs and symptoms do show up, it usually means the damage to your liver is significant, says hematologist Ype de Jong, MD, PhD, an assistant professor of medicine in gastroenterology and hepatology at Weill Cornell Medicine and NewYork-Presbyterian in New York City. “Our message to people is to get tested for hepatitis C before you have symptoms,” Dr. de Jong says. “By the time you have symptoms, it means you are in a bad place.” To that end, the newest government guidelines are for every person to be tested at least once in their lifetime for this virus. For those at higher risk for hepatitis C, which is most commonly transmitted via blood-to-blood contact (think: shared needles), testing recommendations are more frequent. Meanwhile, if you do develop chronic hepatitis C that is not caught and has advanced to the point of liver damage (known as cirrhosis) or liver cancer, these are some of the symptoms and early signs of hepatitis C that you’ll encounter.
Early Warning Signs of Hepatitis C
Easy bleeding and bruising
“If you see someone with lots of bruising, it means there is a problem with blood clotting,” says Eugene R Schiff, M.D., the executive director of the Schiff Center for Liver Diseases at the University of Miami Health System. Part of your liver’s job is to regulate the production of new blood platelets via a hormone called thrombopoietin. When the liver is damaged or scarred, as in the case of cirrhosis, thrombopoietin production slows, leading to a lower platelet count, according to research in the journal Hematology. Without these platelets to help with blood clotting, research shows that you are at greater risk for an increase in bleeding, both internally (bruises) and externally.
Fatigue
As many as 60 percent of people with hepatitis C report fatigue as a primary symptom, according to a study in the World Journal of Gastroenterology. Experts aren’t sure exactly why extreme tiredness occurs as an early warning sign of the disease, but fatigue is both a symptom of hepatitis C and the medications used to treat it, according to a study in BMC Infectious Diseases. “It’s like constantly having the flu,” says Norah Terrault, M.D., a professor of medicine and chief of gastroenterology and liver diseases at the Keck School of Medicine at the University of South California in Los Angeles. “Your body is fighting off a virus, which creates fatigue.” The difficulty, Dr. Terrault points out, is that so many other things can lead to fatigue that it’s hard to tell patients definitively if hepatitis C is the source of their exhaustion. “But it’s one of the most common symptoms,” she adds. Other theories about the cause of hepatitis C-related fatigue include the mental toll of the disease (depression caused by a chronic condition can make you tired). And research from George Mason University in Virginia concludes that the liver’s role in metabolizing various substrates in the blood to provide nutrients to the rest of the body is disrupted by cirrhosis, leading to low energy. Other studies have explored the way chronic hepatitis C may disrupt neurotransmission in the brain. Research in the Canadian Journal of Gastroenterology says it is unclear whether the virus itself is causing these brain changes or whether behavioral changes triggered by the disease are the cause.
Joint pain
You might not associate a disease of the liver with pain in your joints, but there is a connection. Research in the Journal of Musculoskeletal Medicine shows that the same inflammation that causes damage to your liver with hepatitis C can spread to other areas of the body as well, including your joints. “When your immune system is turned on because it is trying to rid your body of this chronic liver infection, some of those immune cells are in your circulation as well,” explains Dr. Terrault. “This can cause inflammation in areas other than your liver, which can lead to symptoms like joint pain.” Despite how common physical aches are with hepatitis C—in one study, musculoskeletal pain affected 70 percent of people with the disease—distinguishing between joint pain related to this virus and other types of rheumatic or arthritic conditions can be tricky, researchers note. The good news? Treatment with direct-acting antivirals generally relieves joint pain along with other symptoms.
Jaundice
You may have seen depictions of jaundice in movies: It’s the guy whose skin is turning the color of pale avocados while the whites of his eyes appear a creepy shade of yellow. It’s a veritable caricature of unwellness—and it’s also a primary sign of cirrhosis—the liver damage caused by hepatitis C. Jaundice occurs when you have too much of a substance called bilirubin in your blood. Bilirubin is essentially a metabolized form of red blood cells, which a healthy liver uses to make bile. The liver is in charge of eliminating excess bilirubin from the body, but when the liver no longer functions properly, as in the case of hepatitis C, there is a buildup of bilirubin in your body, and the yellowish pigment of the substance turns your skin a funky shade. (It’s also the reason your poop may be a very pale color if you have jaundice, since the colorful bilirubin is not being properly excreted.) Despite appearances, though, there is nothing inherently painful about jaundice itself. “Jaundice is a marker for disease severity but not necessarily how you feel,” explains Dr. Terrault. “There is nothing harmful about jaundice itself.”
Dark urine
Most often, you probably associate a dark color of pee with dehydration. (And most often, that’s the case.) But if you have liver damage that affects your body’s ability to properly excrete bilirubin (see jaundice, above) the substance may make its way into your urine, turning it to an orange-brown shade. While the color of urine is a warning sign that your liver may be malfunctioning, recent research in the Journal of Hepatology suggests that certain biomarkers in urine itself may be a better way to evaluate liver failure.
Abdominal and leg swelling
Among the many roles your liver plays, it receives blood from your intestines and spleen. But when cirrhosis occurs, the flow of blood to your liver slows dramatically and begins to back up in the portal vein, which connects the intestines to the liver. This is known as portal hypertension. In turn, portal hypertension causes the blood to divert to smaller veins, and eventually, the increased pressure in these veins can cause them to burst or leak. Leakage from your veins into your stomach or lower extremities is known as ascites, and it is one of the most common symptoms of cirrhosis, according to the Cleveland Clinic in Ohio. “There can be fluid in your belly that is caused by a backup of blood from your intestines that can’t go through to the liver,” says Dr. de Jong. “Essentially, the increased pressure on your veins causes leakage of fluid around intestines and it can feeling like swollen belly.”
Hepatitis C rash
As if swollen limbs and yellow eyes weren’t enough, left unchecked, hepatitis C and cirrhosis can lead to skin rashes called purpura or less commonly a maculopapular rash, as well. “Proteins triggered by the virus circulate in your blood and in the small blood vessels in the legs and cause inflammation, from which you can get a rash,” says Dr. Terrault. “The rash is called purpura and it tends to be on lower extremities. It is considered a classic sign of hepatitis C.” Older literature suggested that an inflammatory condition affecting the mouth was also associated with hepatitis C, says Dr. Terrault, but the current thinking is that the two conditions are separate.
Confusion
When your liver stops functioning properly, it is no longer able to remove toxins from your blood. (Toxins are produced when food, alcohol and medications break down in your body.) Instead, these toxins build up in your bloodstream and eventually travel to your brain, where they cause a condition known as hepatic encephalopathy, which is marked by confusion, disorientation and cognitive impairment. The condition also contributes to memory loss, according to recent research. About 50 percent of people with liver cirrhosis will eventually develop hepatic encephalopathy, the Cleveland Clinic reports. If there’s a silver lining, it’s that the condition can be slowed, stopped and possibly even reversed with proper treatment. Treatment commonly involves antibiotics (to kill off bacteria in your body that naturally create toxins from digested food) and laxatives (which draw toxins in your blood back to your colon where they can be excreted).
Hepatitis C in Women
While symptoms of the virus are similar in women and men, risk factors differ. “For women, the unique risk factors of hepatitis C are related to mother-to-child transmission,” says Dr. Terrault. “There is a 5 percent risk of the virus being transmitted from mother to child.” Certain aspects of cirrhosis also change when women go into menopause, she adds: “The pace of disease progression may be faster since estrogen is protective against hepatitis C,” and estrogen production decreases after menopause. (In fact, a study in the journal Liver International found that estrogen disrupts the ability of the hepatitis C virus to replicate in liver cells.)
Hepatitis C in Men
Again, while symptoms and warning signs of the virus are similar in men and women, the risks of infection vary. “For instance, there is a greater risk of acute infections in men who have sex with men, especially in the HIV community,” says Dr. de Jong, who reiterates that the virus is transmitted by blood contact. “The exact reason is not known, but it may be related to weaker immune systems in this group.” (One recent study suggests that riskier sexual behavior or “sexualized drug use” in this community may play a role.) Then again, Dr. de Jong says, it also could be a reflection of better protection during sex being used in other communities.
Curing Hepatitis C
Today’s direct-acting antiviral medications—oral pills that you take for eight to 12 weeks—are highly effective at killing the hepatitis C virus. The FDA-approved drugs include:
EpclusaHarvoniMavyretVoseviZepatier
“These are combination medications that typically include two or three antivirals in one pill,” says Dr. de Jong. “They work by blocking viral functions and preventing the virus from growing and infecting new cells.” Shutting down the ability of the virus to replicate, he explains, allows the immune system a chance to catch up and attack the existing virus in the liver. Antivirals to treat hepatitis C are a bright spot in recent research, but despite tireless efforts, a vaccine for hepatitis C remains elusive. This is largely due to the constant mutation of the virus so that there are multiple strains of hepatitis C, explains Dr. Schiff. “With hepatitis C, you can cure it through oral drugs that are very safe, but you can also get it again if you go back to the same behaviors that led to infection the first time,” he says. “There are no vaccines to prevent it right now, because there are so many strains of the virus. The real question is, can we develop a vaccine that can work with all these strains?” “For true elimination of hepatitis C, we need to protect people from getting it in the first place,” agrees Dr. Terrault, noting that the most recent vaccine trial for the virus was not successful. Nevertheless, she believes a vaccine for hepatitis is possible. “With the vaccine technology that advanced during COVID, it’s possible some of what we’ve learned can be applied to hepatitis C,” she says. “I remain hopeful that a vaccine for hepatitis C is possible.” Next up: Find out about the anti-inflammatory diet and what foods you can eat on it.
Sources:
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