Clinical Signs and Symptoms of Hepatitis C

Key points

  • Many people with acute or chronic hepatitis C don't look or feel sick and therefore don't know they are infected.
  • Most people with chronic hepatitis C will not have specific symptoms for 20 years or more.
  • If a patient does have symptoms, they are usually non-specific complaints like fatigue or depression.
  • Without treatment, chronic hepatitis C infection can progress to chronic liver disease.
A healthcare professional speaking with a patient in his office

Disease presentation

Most often, clinicians will not recognize hepatitis C virus (HCV) infection until the patient is tested.

Without early diagnosis and treatment, patients with hepatitis C can develop chronic liver disease, which can range from mild to severe. The disease can progress silently and slowly over several decades. In some cases, a routine examination of the patient may show elevated alanine aminotransferase (ALT) enzyme levels either during acute or advanced HCV infection.

For the public‎

For general audiences looking for information on hepatitis C signs and symptoms, see:
Signs and Symptoms

Symptoms

If symptoms of acute HCV infection do occur, they can include:

  • Abdominal pain, nausea, and/or vomiting
  • Dark urine or clay-colored stools
  • Fatigue
  • Fever
  • Jaundice
  • Joint pain
  • Loss of appetite

For those who do develop symptoms, they typically appear 2–12 weeks after exposure, but the window can range from 2–26 weeks.12

Symptoms of chronic HCV infection

Most people with chronic HCV infection experience non-specific symptoms — such as chronic fatigue and depression — or have no symptoms at all. Many eventually develop severe chronic liver disease, including cirrhosis and liver cancer.

Extrahepatic manifestations

Some patients can develop medical conditions from HCV infection not related to the liver. These include:

  • Diabetes mellitus
  • Glomerulonephritis
  • Essential mixed cryoglobulinemia
  • Porphyria cutanea tarda
  • Non-Hodgkin's lymphoma

Clinical assessment

CDC recommends universal HCV screening for all adults 18 and older at least once in a lifetime and all pregnant people during each pregnancy, except in settings where the prevalence of HCV infection is less than 0.1%.

Any person who requests hepatitis C testing should receive it, regardless of disclosure of risk, because many persons may be reluctant to disclose stigmatizing risks.

CDC also recommends routine periodic testing for people with ongoing risk factors including:

  • People who inject drugs.
  • People who share needles, syringes, etc.
  • People who have received maintenance hemodialysis.

Clinicians should test people with risk factors regardless of setting prevalence.

For detailed guidance on testing and determining hepatitis C prevalence, keep reading.

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Content Source:
Division of Viral Hepatitis
  1. National Institute of Diabetes and Digestive and Kidney Diseases. Definition and facts of liver transplant. Available at: https://www.niddk.nih.gov/health-information/liver-disease/liver-transplant/definition-facts.
  2. Organ Procurement and Transplantation Network. Health Resources and Services Administration, US Department of Health and Human Services. National data website. Available at: https://optn.transplant.hrsa.gov/data/view-data-reports/build-advanced.