What are the symptoms of Hepatitis C (HCV) infection?

Symptoms of Hepatitis C Infection

Most patients with hepatitis C infection are asymptomatic, particularly during the acute phase (60-70% have no symptoms) and throughout much of the chronic phase, making this a largely silent disease that progresses insidiously over decades. 1

Acute Hepatitis C Symptoms

Acute infection is typically asymptomatic or causes only mild, nonspecific symptoms:

• 60-70% of patients have no discernible symptoms during acute infection 1
• 20-30% develop jaundice 1
• 10-20% experience nonspecific symptoms including anorexia, malaise, or abdominal pain 1
• The incubation period averages 6-7 weeks from exposure to symptom onset 1
• When symptoms occur, they typically last 2-12 weeks 1

Additional acute phase symptoms may include:

• Fatigue and malaise 2
• Abdominal pain 2
• Mild hepatomegaly and splenomegaly 2
• Arthralgia 2

Chronic Hepatitis C Symptoms

The chronic phase is characterized by an insidious, slow progression without symptoms in the majority of patients during the first two or more decades after infection. 1

When symptoms do occur in chronic infection, they include:

• Fatigue - the most common symptom 1
• Muscle aches 1
• Anorexia (decreased appetite) 1
• Right upper quadrant pain 1
• Nausea 1
• Malaise 2, 3
• Itching 2

Critical clinical caveat: The presence or absence of symptoms is a poor marker of disease severity - some patients with cirrhosis remain completely asymptomatic. 1

Late-Stage Disease Symptoms

When cirrhosis develops, symptoms become more common and include:

• Jaundice 3
• Weakness and wasting 3
• Gastrointestinal bleeding 3
• Ascites 1
• Variceal hemorrhage 1
• Encephalopathy 1

Extrahepatic Manifestations

HCV infection causes immunologic extrahepatic manifestations in some patients:

Well-established associations include:

• Cryoglobulinemia 1
• Membranoproliferative glomerulonephritis 1
• Porphyria cutanea tarda 1

Other reported associations (less definitively established) include:

• Seronegative arthritis 1
• Sjögren syndrome 1
• Autoimmune thyroiditis 1
• Lichen planus 1
• Idiopathic thrombocytopenic purpura 1

Key Clinical Recognition Patterns

Hepatitis C is frequently not recognized until:

• Asymptomatic persons are identified as HCV-positive during blood donor screening 1
• Elevated ALT levels are detected during routine physical examinations 1
• Patients present with complications of advanced liver disease 3, 4

Important diagnostic consideration: Chronic hepatitis C progresses at a slow rate, with cirrhosis developing in 10-20% of persons over 20-30 years, making early symptom-based detection unreliable. 1