Signs & Symptoms That May Be Associated with Hepatitis C
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Information in this section has been updated and adapted from Hepatitis C Choices 4th Edition, Signs and Symptoms That May Be Associated with Hepatitis C written by Tina M. St. John. MD
Hepatitis C affects different people in different ways. Your experience with hepatitis C will be as unique as you are. This chapter reviews the most common signs and symptoms experienced by people with chronic hepatitis C. At first glance, the mere length of the chapter may appear overwhelming. But keep in mind, this is just a list of possibilities. Many people with hepatitis C have no symptoms.
If you have any of the signs or symptoms described in this chapter, it is important not to assume they are a result of having hepatitis C. Your healthcare provider can determine if they are associated with your hepatitis C. Many symptoms come and go on their own. For troublesome and/or persistent problems, there are things you and your healthcare provider can do to either make them go away, or make them easier to live with.
You may be wondering what the difference is between a sign and a symptom. A sign is an abnormality detected by your healthcare provider during an examination. A symptom is something you, as a person with hepatitis C, experience because of the virus. Signs and symptoms are discussed together because sometimes a sign is also a symptom. Fever is a good example of something that is both a sign and a symptom. Your healthcare provider can take your temperature and detect a fever, so it is a sign. But if you have a fever, you experience its discomfort, so fever is also a symptom.
There are three sections following this introduction. The first section briefly explains how the hepatitis C virus causes disease. The second section reviews possible signs and symptoms that people with hepatitis C who do not have cirrhosis may experience. The last section reviews additional signs and symptoms that people with hepatitis C who have cirrhosis may experience.
How the Hepatitis C Virus Causes Disease
According to current understanding, the hepatitis C virus (HCV) causes disease in two general ways. The first is by infecting cells. Once inside the cell, the virus directly damages or kills the cell. This mechanism is called cytopathic damage. The second way the hepatitis C virus causes damage is by provoking an immune response. The immune system is your body’s way of protecting itself from invading agents such as viruses and bacteria. An overactive or misdirected immune response can damage infected cells and the normal surrounding tissues. This mechanism is called immunopathic damage.
When HCV was first discovered, experts thought the virus infected only liver cells. However, research has revealed that HCV also infects parts of the immune system, specifically the lymphatic system and peripheral blood mononuclear cells.
Experts now understand that hepatitis C is not just a liver disease, but is a systemic disease, meaning it can affect nearly any organ of the body. As you read the list of possible signs and symptoms associated with hepatitis C infection, you may find some of the symptoms you have been experiencing that you thought were caused by something else may actually be caused by hepatitis C. This is important because knowing why you are having a symptom is often the first step in alleviating the symptom, or making it less troublesome.
Generalized Signs and Symptoms of Hepatitis C Without Cirrhosis
The possible signs and symptoms of hepatitis C without cirrhosis involve every organ system of the body. Although some of these symptoms can be quite uncomfortable, most of them do not indicate that your liver disease is getting worse. New symptoms should always be discussed with your healthcare provider so you can work together to keep your life with hepatitis C as active, productive, and enjoyable as possible. The lists are presented in alphabetical order to make it easier to look up those signs and symptoms of interest to you.
Arthralgia is pain in the joints. Frequent sites of joint pain are the hips, knees, fingers, and spine, although any joint can be a source of pain. Arthralgia associated with hepatitis C can be migratory, meaning the discomfort moves from one location to another over time. You may have pain in your hip one day and in your knee the next. This symptom usually comes and goes, and is rarely present all the time.
If you experience joint pain, it is important to talk with your healthcare provider before taking anything to treat the pain because some over-the-counter pain medicines such as acetaminophen are potentially harmful to the liver.
Fatigue is feeling tired. Nearly all people with hepatitis C experience fatigue at one time or another. The fatigue may be mild and relieved by naps or going to bed early. However, fatigue can be severe, feeling like near exhaustion even after a full night of sleep. Fatigue experienced by people with hepatitis C may also be accompanied by feelings of anger, hostility, and depression. These feelings may persist even after the fatigue has passed.
Fever, Chills, and Night Sweats
Many people with the hepatitis C virus (HCV) experience fevers from time to time. The fevers are usually low, typically less than 101 degrees Fahrenheit. As the fever comes down, you may experience chills and sweating. You may have fevers only at night. If this happens, you may wake up with your bedclothes and/or your sheets wet with sweat. This experience is called night sweats.
Fluid retention occurs when your body holds on to more water than it needs. The extra water leaks into the tissues. You may notice swelling of your feet, ankles, fingers, and/or face. People with fluid retention often have frequent urination, especially at night.
People with hepatitis C can experience periodic flu-like syndromes. These episodes usually last a few days, rarely more than a week. The most common symptoms are fever, chills, headache, fatigue, and/or muscle aches.
Lymphadenopathy is swelling of the lymph nodes. Lymph nodes are normally about the size of a pea. Because HCV infects the lymphatic system, it frequently causes the lymph nodes to swell. The lymph nodes of the armpits, groin, and neck are relatively close to the skin surface, and are usually examined to see if you have lymphadenopathy. If you have lymphadenopathy, it may or may not be painful when you press on the swollen lymph nodes.
Myalgia is muscle pain or aching. This symptom is typically experienced as a generalized feeling. However, some people report pain in only one area of the body. Myalgia tends to come and go, and is rarely present all the time. If you experience muscle aches or pain, it is important to talk with your healthcare provider before taking anything to treat the pain because some over-the-counter pain medicines are potentially harmful to the liver.
Pruritus is the medical word for itching. People with hepatitis C sometimes have pruritus. Often, it is limited to the palms of the hands and/or the soles of the feet. However, some people have generalized pruritus, meaning they itch all over.
Insomnia is difficulty sleeping. It occurs in different forms. You may have trouble falling asleep, or you may wake up often during the night. Some people report having unusually vivid, intense, and/or frightening dreams. Such dreams can contribute to insomnia.
Spider nevi are small, red, spider shaped spots on the skin. They are usually less than ½ inch around. They are most commonly seen on the face and chest, but can occur anywhere on the skin. Spider nevi are painless and do not itch.
People with hepatitis C sometimes experience a sense of weakness. This symptom can vary from mild to severe, and tends to come and go.
Abdominal and Digestive System Signs and Symptoms
You may experience episodes of abdominal pain if you have hepatitis C. Pain on the right side just below the ribs is likely to be from the liver. People usually report this pain as being short, sharp, or stabbing. More constant, cramping pain closer to the middle of chest, but under the ribs, can be due to gall bladder problems that may accompany hepatitis C. You may experience pain elsewhere in the abdomen.
If you experience any new pain in the abdomen, it is important for you to tell your healthcare provider right away so the source of the pain can be determined.
Appetite changes and Weight loss
People with hepatitis C often report changes in appetite. You may find you no longer want the foods you once enjoyed. Many people find they are particularly put off by fatty foods and alcohol. For some, foods at room temperature or served cold are more appealing than hot foods. The distaste for alcohol is actually good for you because alcohol increases the damage done to the liver by HCV. People with hepatitis C should not drink any alcohol including beer, wine, wine coolers, and mixed drinks.
If changes in your appetite are causing weight loss, discuss this with your healthcare provider because good nutrition is particularly important for people with hepatitis C.
Bloating is usually described as a feeling of fullness in the abdomen. You may notice your clothes seem tight around your waist. This bloating may or may not be accompanied by weight gain. Talk with your doctor about any new bloating you experience.
Diarrhea can be experienced as unusually loose stools or an increase in the frequency of bowel movements, with or without a change in the consistency of the stool. Persistent diarrhea, especially if accompanied by weight loss, should be discussed with your doctor right away.
Indigestion and heartburn
Indigestion is typically experienced as an uncomfortable feeling of fullness in the stomach. It is often accompanied by queasiness and burping of a mixture of gas and stomach contents. When this occurs, you may notice a burning feeling in your throat and/or a sour taste in your mouth. Heartburn is experienced as pain or burning in the chest under the breastbone. It, too, may be accompanied by burping of gas and stomach contents. Both indigestion and heartburn can be brought on by and last longer after a fatty meal.
Jaundice is a yellowish discoloration of the skin and/or the whites of the eyes. It is caused by a yellow substance in the blood called bilirubin. The liver normally breaks down bilirubin. If the liver is not working normally, bilirubin can build up in the blood and begin to stain the skin.
Nausea is the feeling that you may vomit. Although it is usually not accompanied by vomiting, nausea can be a very uncomfortable and debilitating symptom. If you are experiencing nausea, talk with your healthcare provider because there are many ways to treat this symptom.
Cognitive, Mood, and Nervous System Signs and Symptoms
Cognition is your ability to think clearly and to concentrate. Some people with hepatitis C notice changes in their cognitive ability. This can take several different forms. You may find you cannot concentrate for long periods of time, or may notice your thought processes seem slower than usual. You may have a hard time coming up with words you want to say, or may just feel mentally tired. These cognitive changes are sometimes called “brain fog.” Like other symptoms of hepatitis C, these cognitive changes often come and go. Always discuss cognitive changes with your doctor as they may or may not be related to hepatitis C.
Hepatitis C does not directly cause depression, but concerns about the disease and changes it may cause in your life can lead to depression. Some of the symptoms of depression include:
- sleeping more or less than usual
- eating more or less than usual
- lack of interest in your usual activities
- feelings of sadness and/or despair most of the time
If you have one or more of these symptoms, you may have depression. Depression can seriously interfere with your quality of life and make it difficult for you to take care of yourself. Depression is nothing to be ashamed of, and it can be treated. If you have any of the symptoms of depression, talk to your healthcare provider right away.
Some people experience dizziness as feeling as if they are going to faint. Others experience dizziness as disorientation, or feeling as if the world is spinning around them. Both of these symptoms have been reported by people living with hepatitis C. If you are experiencing dizziness, talk with your healthcare provider because this can be not only troublesome but also dangerous.
Headaches are common and may be part of your experience with hepatitis C. The pain can range from minor to severe. If you are having headaches, talk to your healthcare provider before taking any medicines for your headaches because some over-the-counter pain medicines can be harmful to your liver.
Some people with hepatitis C report sudden mood swings. Mood swings may be related to depression, anxiety, or the medications you are taking.
Numbnesss or tingling
A number of people with hepatitis C have numbness or tingling in their extremities (arms, legs, fingers, or toes). Most people with numbness or tingling feel it in their fingers and toes, but it may extend into the arms and legs. Numbness is a decreased sense of feeling. In its most severe form, the affected areas have no feeling. Tingling can be painful. People describe painful tingling as feeling like being stuck with pins. This symptom tends to come and go.
A number of visual changes can accompany hepatitis C infection. You may find you are not seeing as clearly as you once did. Peripheral vision, the ability to see things that are at the sides of your view, can also be diminished. Some people report seeing small specks called “floaters” moving across their view. This can occur when the eyes are open or closed. Any sudden changes in vision should be reported to your doctor right away.
Another symptom you may experience is dryness of the eyes, or feeling as if there is something scratchy in your eyes. All of these symptoms can come and go.
Other Signs and Symptoms
Blood sugar abnormalities
The symptoms of low blood sugar are worst when you have not eaten for several hours, and are relieved by eating or drinking something. If you are having any of the symptoms of either high or low blood sugar, tell your healthcare provider right away.
Hepatitis C can cause chest pain, usually a form of heartburn. However, chest pain can also be a symptom of serious heart or lung disease. If you have chest pain, contact your healthcare provider immediately.
Menstrual and menopausal changes
Women with hepatitis C have reported menstrual changes such as irregular periods, spotting, or increased premenstrual symptoms. Menopausal women may experience an increase in menopausal symptoms such as hot flashes and mood swings.
A heart palpitation is involuntarily becoming aware of your heart beating. Palpitations occur in different forms. You may feel your heart is beating harder or faster than usual, or that it is beating irregularly. If you have palpitations, you need to tell your healthcare provider immediately so he or she can make sure you are not having a problem with your heart.
Some people with hepatitis C have a decreased interest in sexual activity. Decreased sexual response and lack of intensity of sexual response have also been reported. Sexual changes can be quite upsetting. If you are experiencing sexual ﾭvider, and your partner can do to help you have a satisfying sex life.
Signs and Symptoms of Hepatitis C With Cirrhosis
Approximately 20% to 40% of people with chronic hepatitis C go on to develop liver cirrhosis over a period of 10 to 40 years. Because blood cannot flow well through a cirrhotic liver, blood backs up in the vessels leading to the liver. This back up leads to an increase in pressure in those blood vessels, a condition known as portal hypertension. Many of the signs and symptoms of cirrhosis are related to portal hypertension. The liver has many functions, so there are a number of things that can go wrong when the liver is not functioning normally. Abnormal liver function causes the other signs and symptoms of hepatitis C with cirrhosis.
Portal hypertension can cause fluid to leak from the blood vessels leading to the liver. This fluid builds up in the abdomen and is called ascites. Ascites causes the abdomen to become distended or enlarged. This can be experienced as bloating or a feeling of persistent fullness in the gut.
The liver produces many of the substances needed for normal blood clotting. A cirrhotic liver may not produce enough of these substances for normal clotting. If you have a cirrhotic liver and begin bleeding for any reason, it may be difficult to get the bleeding stopped.
Cirrhosis can lead to a deficiency in vitamin D. This can cause softening of the bones and bone pain. This pain is most often felt in the legs, hips, and spine.
Cirrhosis can lead to a deficiency in vitamin K and low levels of clotting factors in the blood. This can lead to easy bruising. If you are experiencing easy bruising, tell your healthcare provider because this symptom can often be reversed with appropriate treatment.
Caput medusae refers to enlarged, visible veins that start at the navel and spread out and up over the abdomen. They are caused by portal hypertension.
Gastroesophageal varices are another complication of portal hypertension. Varices are enlarged, fragile veins found where the esophagus (the tube that takes food from your mouth to your stomach) meets the stomach. These veins can burst and bleed.
If you have cirrhosis and begin to vomit blood, you must call an ambulance and get to an emergency room as soon as possible to get the bleeding stopped.
Glossitis is a sore tongue. If you have glossitis, your tongue will be redder than usual and will be sensitive to salty and sour foods, and carbonated beverages.
Hemorrhoids are enlarged, fragile veins found around the anus (the opening through which your bowel movements pass). Hemorrhoids can be a complication of portal hypertension. Hemorrhoids may bleed occasionally. If the bleeding persists or is frequent, be sure to discuss it with your healthcare provider.
Hepatic encephalopathy is one of the most serious complications of cirrhosis. It can occur in an acute form that develops over a period of days to weeks, or it can occur in a chronic form that develops over a period of months to years. A number of different symptoms may indicate hepatic encephalopathy, but all of them indicate abnormalities of the nervous system. Early symptoms include euphoria (feeling unusually happy for no apparent reason), depression, confusion, slurred speech, or abnormal sleeping patterns.
If these symptoms are not treated, they can progress to severe confusion, incoherent speech, tremors, and rigidity. It is urgent for these symptoms to be treated or you could fall into a coma. With the acute form of hepatic encephalopathy, treatment will usually reverse all of the symptoms. However, with the chronic form, some of the symptoms may not be reversible.
Melanosis is a gradual darkening of those areas of skin that are exposed to the sun. The skin tends to get darker over time.
Cirrhosis can lead to a deficiency in vitamin A. This can lead to episodes of night blindness (poor vision in the dark). If this occurs, be certain to talk about it with your healthcare provider because this symptom is often reversible.
Shortness of breath
Shortness of breath can develop as a complication of portal hypertension. Some people experience this symptom only at night; others experience it during the day as well. If you are having shortness of breath, discuss it with your healthcare provider.
Steatorrhea is the passing of fat in your bowel movements. The presence of fat in the stool makes the stool smell particularly bad and causes it to float in the toilet bowl. Steatorrhea is usually accompanied by an increased amount of stool and intestinal gas.
Xanthelasmas are small deposits of fat just under the surface of the skin around your eyes. They appear as small, raised, yellowish bumps on the skin.
Xanthomas are small deposits of fat just under the surface of the skin over your joints and/or tendons. They appear as small, raised, yellowish nodules.
The experience of living with hepatitis C is quite different from one person to another. It is also variable for each person over time. There will probably be days when you feel great. At other times, you may feel overwhelmed by signs and symptoms associated with hepatitis C. And there will likely be still other times when you feel somewhere in between these two states. Below are a few things you may find helpful to keep in mind about your signs and symptoms as you learn to live with hepatitis C.
Discuss your signs and symptoms with your healthcare provider. There are many ways to treat the signs and symptoms associated with hepatitis C, so there is no need to suffer in silence.
Always tell your healthcare provider if you experience a new sign or symptom. Doing this will help them in their efforts to help you feel your best.
Keep all of your healthcare providers informed about what treatments, medicines, and supplements you are using to manage your hepatitis C. Different treatments may interact with one another and cause side effects you may experience as new signs or symptoms. Do not panic if you start to experience new signs or symptoms. Although many of the signs and symptoms associated with hepatitis C can be troubling, they do not necessarily mean your liver disease is getting worse.
- Dolan, M. The Hepatitis C Handbook, 2nd ed. Berkeley, California: North Atlantic Books; 1999.
- Fauci A, Braunwald E, Isselbacher K, Wilson J, Martin J, Kasper D, Hauser S, Longo D, eds. Harrison’s Principles of Internal Medicine. 14th ed. New York, New York: McGraw Hill Companies; 1998.
- Mandell G, Bennett J, Dolin R, eds. Principles and Practice of Infectious Diseases. 4th ed. New York, New York: Churchill Livingstone; 1995.