About 75% of people have no symptoms when they first acquire hepatitis C infection. The remaining 25% may complain of fatigue, loss of appetite, muscle aches, or fever. Yellowing of the skin or eyes (jaundice) is rare at this early stage of infection.

Over time, the liver in people with chronic infection may begin to experience the effects of the persistent inflammation caused by the immune reaction to the virus. Blood tests may show elevated levels of liver enzymes, a sign of liver damage, which is often the first suggestion that the infection may be present. Patients may become easily fatigued or complain of nonspecific symptoms.

As cirrhosis develops, symptoms increase and may include :

• Weakness.
• Loss of appetite.
• Weight loss.
• Breast enlargement in men.
• A rash on the palms.
• Difficulty with the clotting of blood.
• Spider-like blood vessels on the skin.

In patients with advanced cirrhosis, the liver begins to fail. This is a life-threatening problem. Confusion and even coma (encephalopathy) may result from the inability of the liver to process certain toxic substances.

Increased pressure in the blood vessels of the liver (portal hypertension) may cause fluid to build up in the abdominal cavity (ascites) and result in engorged veins in the swallowing tube (esophageal varices) that tear easily and can bleed suddenly and massively. Portal hypertension also can cause kidney failure or an enlarged spleen, resulting in a decrease of blood cells and the development of anemia, increased risk of infection and bleeding.

In advanced cirrhosis, liver failure causes decreased production of clotting factors. Patients with advanced cirrhosis often develop jaundice because the damaged liver is unable to eliminate a yellow compound called bilirubin that is formed from the hemoglobin of old red blood cells.

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