Disease progression is indolent, and the time course is highly variable. The incubation period of acute hepatitis C averages 7 weeks. Acute hepatitis C is usually asymptomatic or causes only mild symptoms. Patients may remain asymptomatic from acquisition of the virus all the way to end-stage liver disease. The disease often comes to light during blood donor screening or routine physical examination, when elevated transaminase levels are detected on blood testing.
Some patients have fatigue, which on rare occasions can be disabling.
Diagnostic evaluation Chronic hepatitis C should be suspected in any case of unexplained elevation of serum transaminase levels. Initial testing consists of measuring serum HCV antibodies. Identification of viral RNA by reverse transcriptase polymerase chain reaction aids in confirming the diagnosis and can help suggest a prognosis. A positive HCV-antibody test in patients with risk factors for exposure or elevated liver enzyme levels confirms chronic infection. In low-risk patients, confirmatory antibody testing with the recombinant immune blot assay is appropriate.