Hepatitis C: Who Should Get Tested

Hepatitis C is a viral infection targeting the liver and one of the most common bloodborne infections in the United States. An estimated 4 million people in the United States and over 58 million worldwide are infected with the hepatitis C virus (HCV). The condition is particularly insidious because people can carry the virus for years or decades without any symptoms, while the infection quietly damages liver tissue.

More than half of people who become infected with HCV develop chronic infection, which can progress to serious liver disease, including cirrhosis, liver cancer, and liver failure. However, hepatitis C is now highly treatable. Modern direct-acting antiviral medications can cure the infection in most patients within 8 to 12 weeks, making early detection through testing one of the most consequential steps a person can take for their long-term liver health.

Hepatitis C is transmitted through direct blood-to-blood contact, as the virus enters the bloodstream through percutaneous exposure to infected blood. Injection drug use is the most common transmission route, accounting for the majority of new infections.

Populations at highest risk include people who currently or formerly injected drugs, HIV-positive men who have sex with men, individuals with a history of incarceration, and people born between 1945 and 1965 (the baby boomer cohort, which carries a disproportionate share of chronic infections). People who received blood transfusions, organ transplants, or clotting factor concentrates before screening protocols were implemented in the early 1990s are also at elevated risk. Other potential transmission routes include sharing personal items that may carry blood (razors, toothbrushes), tattooing or piercing with unsterile equipment, and occupational needlestick injuries in healthcare settings.

The CDC recommends that all adults aged 18 and older be screened for hepatitis C at least once, and that pregnant individuals be tested during each pregnancy. More frequent or targeted testing is recommended for people who inject drugs or have previously done so, individuals with HIV, children born to HCV-infected parents, and anyone with ongoing risk exposures.

Anyone experiencing unexplained symptoms such as persistent fatigue, abdominal discomfort, or changes in urine or stool color should consider testing. Individuals who have received long-term hemodialysis or who have persistently elevated ALT levels are also considered at increased risk. Because hepatitis C can silently damage the liver for years before symptoms appear, testing is appropriate even without symptoms when risk factors are present.

Hepatitis C testing typically begins with an antibody test. A positive antibody result indicates exposure to the virus at some point but does not by itself confirm active infection. When antibodies are detected, the laboratory performs a reflex RNA test to determine whether the virus is currently present in the bloodstream. Detectable RNA confirms active infection requiring treatment, while undetectable RNA suggests the infection has been cleared, either spontaneously or through prior treatment.

Liver function tests may show elevated enzymes even when no symptoms are present, but enzyme levels do not reliably predict the degree of liver damage. ALT levels can be normal even in the presence of significant fibrosis or cirrhosis, and elevated ALT does not always mean the liver damage is from hepatitis C. These results should be interpreted by a healthcare provider who can recommend appropriate follow-up, including assessment of liver fibrosis and discussion of curative antiviral treatment options.

Protecting liver health is especially important for individuals with hepatitis C or awaiting test results. Avoiding alcohol is critical, as it accelerates liver damage in the presence of the virus. A balanced diet emphasizing fruits, vegetables, and whole grains supports liver function, and regular physical activity can help manage fatigue and improve overall well-being.

Preventing transmission to others is essential. Personal items that might carry traces of blood, such as razors and toothbrushes, should not be shared. Tattoos and piercings should be obtained only from licensed facilities using sterile equipment. Healthcare providers should be informed of hepatitis C status to ensure appropriate precautions during medical and dental procedures.