Hepatitis C—or hep C—is a progressive disease. It starts with exposure to the hep C virus and develops into an acute infection. In most cases, there are no symptoms in the acute phase and people may not even realize they are sick. Sometimes, people get better without treatment, but most develop chronic hep C. And chronic hep C can lead to liver damage and even liver failure. Because so many people are unaware of their illness, it’s common for individuals to find out they have hep C when it’s already chronic and causing symptoms. After a hep C diagnosis, you and your doctor will have some decisions to make. You’ll need to check your liver’s health and decide if you need to start treatment. Fortunately, new treatments in recent years are now able to effectively cure hepatitis C and remove all traces of the virus from your blood. You’ll also need to decide what lifestyle changes could help your liver and your health. All along the way, your doctor will monitor your progress. If treatment clears your infection and you don’t have fibrosis (scarring of your liver), your doctor will monitor you just like someone who never had hep C. Viral load measures the amount of virus in your blood. If you test positive for the hep C antibody, your doctor will check to see if you actually have the virus in your blood. Some people fight off the acute infection and will react to the antibody test, but they don’t have the virus in their blood. For these people, it may not be necessary to monitor them any longer. If you do test positive for the virus in your blood, your viral load level is important. It can suggest how likely you are to respond to treatment. Generally, lower viral loads mean treatment has a better chance of helping. Your doctor will check your viral load with a blood test. Once you have your viral load, your doctor won’t need to repeat a viral load test unless you start your treatment. Then, your doctor will monitor your viral load before, during and after your course of medical care. It helps guide decisions about stopping medication and tells your doctor how well you responded. Your doctor may also use it to check for recurrence after treatment in some cases. Liver function tests (LFTs) measure your liver’s health. The easiest way to monitor your liver’s health is to measure liver enzyme levels. These enzyme levels will go up when liver cells become damaged. There are four liver enzymes that make up these liver function tests—or LFTs—along with albumin and bilirubin. Your doctor will likely check your LFTs on a regular basis. Clinic visits and phone calls help keep you on track. When you start treatment, your doctor or clinic will likely keep in touch with you regularly. This contact is important to monitor for side effects and drug interactions. It also helps keep you on track with your medicine. Hep C treatment lasts for weeks and sticking with it can sometimes be a challenge, although newer drugs are easier to take and tolerate. Contact with your treatment team supports your progress. Lab tests monitor for medication problems. Some older hep C medicines can be difficult to take because they cause side effects. For example, ribavirin can cause a blood disorder. So if you’re taking certain hep C medicines, your doctor may monitor some lab tests while you’re on treatment. The tests you need will depend on your treatment regimen. Signs and symptoms of cirrhosis can show disease progression. Your doctor will monitor for cirrhosis—advanced scarring of the liver—if you have fibrosis or you don’t fully respond to treatment. This includes checking LFTs, a complete blood count, and blood clotting function. A painless needle biopsy permits the doctor to see microscopic changes in the liver. Your doctor will also want to know if you’re having any symptoms. Symptoms of cirrhosis include fatigue, appetite loss, nausea, itchy skin, yellowish skin, and bruising or bleeding easily. Endoscopy monitors for varices in cirrhosis. If you develop cirrhosis, it’s important to know if you have varices. Varices are enlarged veins in the stomach and esophagus of people with cirrhosis. They’re kind of like varicose veins in the legs. About half of people with cirrhosis will develop varices. Varices are the most lethal complication of cirrhosis because they can rupture and hemorrhage. Fortunately, endoscopy can find varices and lead to treatment before they cause problems. Your doctor will likely recommend regular monitoring for varices if you have cirrhosis. Ultrasound testing can find liver cancer. People who develop fibrosis or cirrhosis are at higher risk of developing liver cancer. And liver cancer can be tricky to find in the early stages. Current recommendations suggest using ultrasound to monitor for liver cancer in people at high risk. If you have advanced fibrosis or cirrhosis, your doctor may recommend an ultrasound every 6 to 12 months.