After a Hepatitis C Diagnosis: What to Expect From Treatment

If you’ve been diagnosed with hepatitis C — a viral infection that causes liver inflammation — you aren’t alone. An estimated 2.7 to 3.9 million people in the United States have chronic hepatitis C, according to the  National Institute of Diabetes and Digestive and Kidney Diseases, and more than half do not realize they have it.

Hepatitis C is spread primarily through direct exposure to infected blood. While some people may clear the virus from their body naturally within several months, the American Liver Foundation estimates 75 to 85 percent of people with hepatitis C go on to develop chronic hepatitis C. Untreated hepatitis C might eventually lead to cirrhosis (severe scarring of the liver) or liver cancer.

In the past, most people with chronic hepatitis C were baby boomers —  adults born between 1945 and 1964 — who either experimented at one time with intravenous drug use or may have received infected blood during a transfusion, before the blood supply was screened for the virus.

But a report published in April 2020 by the Centers for Disease Control and Prevention (CDC) found that millennials (defined as people born between 1981 and 1996) were about as likely to be diagnosed with hepatitis C as baby boomers, most likely because intravenous drug use is increasing among younger adults as a result of the opioid epidemic, says Steven L. Flamm, MD, a professor of medicine and hepatic disease specialist at Northwestern Memorial Hospital in Chicago.

The CDC now recommends that every adult get tested for hepatitis C at least once. The organization also recommends screening all women during pregnancy and anyone with hepatitis C risk factors, including people who’ve ever used intravenous drugs.

The good news: More than 90 percent of people living with the virus can be cured in just eight to 12 weeks with drugs that have been developed in recent years, according to the CDC. These newer medications are far more effective (and trigger far fewer side effects) than previous treatments.

If you’ve been diagnosed with hepatitis C, your doctor will likely give you a number of tests that will help guide your treatment and prescribe a medication that can clear the virus from your body. Here’s what to expect.

Tests to Measure Liver Function and Damage

Because the hepatitis C virus can damage your liver, your doctor will perform or order tests to assess your liver health.

Most people have already had a set of liver blood tests by the time they’re diagnosed, says Dr. Flamm. But once the disease is confirmed, more tests are often necessary to get a clearer sense of the damage. These may include:

• Blood tests
• Imaging tests
• Liver biopsy (rarely)

If you’re starting treatment, your doctor will likely order a viral load test, which measures the concentration of the hepatitis C virus in your blood, according to the U.S. Department of Veterans Affairs (VA). This test can also serve as a baseline to compare with additional tests in the future that measure how well your treatment is working.

Imaging tests to assess liver damage may include an ultrasound, computed tomography (CT) scan, or magnetic resonance imaging ( MRI). Flamm says that doctors usually have anyone who has hepatitis C get an ultrasound. “Sometimes you can see if damage is present, because the liver looks abnormal,” he says.

In addition to spotting scar tissue in the liver — known as cirrhosis — an ultrasound can detect early forms of liver cancer, usually before any symptoms develop. This is important, Flamm says, because having both hepatitis C and cirrhosis increases the risk of liver cancer.

If an ultrasound shows signs of cirrhosis or cancer, a CT scan or MRI may be used to get a more detailed picture of your liver. But because they tend to be expensive, Flamm says, “We usually only do those tests if we’re really worried or suspicious of something.”

In the past, it was common for doctors to recommend a biopsy — a small tissue sample — of the liver to assess the damage done by hepatitis C, but thanks to the improvement of blood tests and imaging scans, that’s no longer the case. Still, if other tests give a conflicting picture of liver function or damage, “The biopsy is considered the gold standard,” Flamm says.

Genotype Testing for Hepatitis C

Your doctor will also order a blood test to determine the genotype, or strain, of your virus.

“There are six different strains of hepatitis C around the world,” Flamm explains. “They’re all slightly different from one another, but the treatment is now the same for all of them.”

About 75 percent of people with hepatitis C in the United States have genotype 1, according to the VA. Another 20 to 25 percent have genotype 2 or 3, while the rest have genotype 4, 5, or 6.

Treating Hepatitis C With Antiviral Drugs

Once your liver has been assessed and the genotype determined, your doctor will most likely start you on an antiviral medication.

In the past, antiviral treatments caused severe side effects or other health problems, but the newer, direct-acting antiviral drugs are much more effective than older treatments and have fewer side effects. That means almost everyone with hepatitis C is a candidate for treatment, says Flamm.

The treatment you’re prescribed will depend on whether you have advanced cirrhosis, what other medications you are on, and whether hepatitis C treatments have failed in the past, says Flamm. The goal is to reduce your viral load to undetectable levels around 12 weeks after your treatment ends.

In the end, the choice of treatment may come down to what your insurance covers. But, says Flamm, “They all are well tolerated, and they all work essentially the same in terms of their cure rates.”

You might wonder if treatment is necessary if you’re not experiencing any symptoms from your hepatitis C, which is the case for most people, according to Flamm. But even if you’re not sick now, your hepatitis C will likely catch up with you if it isn’t treated.

It can take people with hepatitis C decades before they develop cirrhosis, says Flamm. “People get sick, finally, when they’re in their 50s and 60s,” he says.

Flamm emphasizes that there is no reason to wait to act. “We can get rid of this contagious virus so easily now,” he says.