Typical Symptoms


4 phases of HCV infection: Acute, Chronic, Cirrhosis, & De-compensation/Failure
4 phases of HCV infection: Acute, Chronic, Cirrhosis, & De-compensation/Failure

DO NOT SELF-DIAGNOSE.  The list of symptoms below is not exhaustive, and overlaps with symptom lists of many other diseases. A diagnosis of hepatitis C requires further confirmation through medical testing.
Important points:

  • Most people with hepatitis C virus (HCV) are asymptomatic (no symptoms) for many years.
  • There are four major phases of hepatitis c (acute, chronic, cirrhosis, and de-compensation/failure), each with its own possible symptoms.
  • It is highly unlikely that anyone will have all the possible symptoms of a phase; very often they will have none of them.
  • Everyone is unique in the way their body reacts to HCV.
  • Often abnormal blood tests are the only signs of infection; even these are sometimes normal for many years while serious damage is being done to the liver.
  • Use of alcohol or co-infection with HIV worsens the symptoms and hastens the progression of hepatitis C.

Possible Symptoms of Acute hepatitis C

  • almost indistinguishable from acute hepatitis B infection
  • frequently asymptomatic (there are no symptoms), even when liver tests are abnormal
  • flu-like illness with fatigue, fever, muscular aches and pain, nausea and vomiting
  • about 10% of patients become jaundiced (their skin turns yellow)
  • generally these symptoms resolve and the patient has no symptoms of liver disease for many years
  • symptoms may occur from two weeks to six months after exposure but usually within two months.

Possible Symptoms of Chronic hepatitis C (in general order of frequency) – View images of “Stages 1 – 3” in Stages of Liver Disease.

  • fatigue, ranging from no symptoms at all, to gradually progressive fatigue and lack of energy, to complete debility; can vary widely between individuals and over time
  • joint and muscle pain
  • memory loss and mental confusion
  • skin problems such as dry or itchy skin, rashes, and spots, red palms, spider veins, lichen planus
  • depression, anxiety, irritability
  • indigestion, nausea, vomiting, gas, constipation or diarrhea, and inability to digest certain foods (especially common: some fats, proteins, and dairy products)
  • metabolic syndrome, pre-diabetes, fatty liver disease
  • sleep disturbances
  • pain or discomfort in abdomen, especially upper right quadrant
  • loss of libido
  • chills, sweating, hot/cold flashes
  • eye or eyesight problems, dry eyes
  • hyper-sensitivity to heat or cold
  • vertigo, dizziness, lack of coordination, tinnitus, hearing loss
  • flu-like symptoms
  • headaches
  • urinary tract infections, kidney infections, and strange odor or colouration to the urine
  • fever
  • slow healing and recovery
  • susceptibility to illness, infection, flu (or sometimes the opposite -some have an usually low susceptibility to illness due to a hyperactive immune system continually fighting HCV)
  • weight gain, water retention, swelling of stomach, legs, or feet (edema)
  • menstrual problems
  • appetite loss/weight loss
  • oral or mouth sores or dental problems, dry mouth
  • excessive bleeding (nosebleeds, longer clotting time, occasional bloody stools)
  • various autoimmune disorders such as sicca syndrome, chronic polyarthritis, polydermatomyositis, fibromyalgia, autoimmune thyroiditis, lung fibrosis, and diabetes mellitus may develop
  • extra-hepatic effects of HCV (those affecting organs other than liver) can impact kidneys and urinary tract system, skin, joints and bones (including osteoporosis – even in men and young people), blood vessels, heart and circulatory system (including vasculitis and heart disease), nervous system and brain


Fatty liver can greatly worsen symptoms of Chronic HCV.

Possible Symptoms of Hepatitis C-related Cirrhosis – View images of “Stage 4” in Stages of Liver Disease.

  • all of symptoms of chronic hepatitis C increase in severity, plus the following
  • progressively more severe fatigue
  • increased loss of appetite and loss of weight
  • easy bruisability
  • jaundice (yellow skin)
  • icterus (yellow eyes)
  • dark urine (the color of cola)
  • ascites or abdominal fluid accumulation and swelling (one symptom of this is sudden weight gain)
  • bleeding into the stomach, bloody stool and variceal rectal bleeding (caused by portal hypertension)
  • bleeding into the esophagus and variceal oral bleeding, coughing up/vomiting blood (caused by portal hypertension)
  • muscle wasting
  • swelling of spleen
  • severe itching (caused by bilirubin buildup under skin)
  • mild encephalopathy resulting in forgetfulness, disorientation and/or confusion

Possible Symptoms of Hepatitis C-related Liver De-compensation and Failure (end-stage liver disease)

  • all of symptoms of hepatitis C-related Cirrhosis increase in severity, plus the following
  • liver cancer (HCC or hepatocellular carcinoma)
  • kidney failure
  • life-threatening variceal bleeding – oral or rectal
  • severe ascites or swelling of abdomen
  • severe encephalopathy resulting in debilitating disorientation, dementia, and/or hepatic coma

For more details on the symptoms and how to deal with them, see HepCBC’s FAQs.