Nearly 4 million people in the United States test positive for hepatitis C, many of whom are unaware of their infection. It is usually discovered inadvertently when an individual undergoes a physical exam for insurance purposes, donates blood or asks to be tested because of a known risk factor (Table 1). Rarely do patients present with overt symptoms of acute hepatitis, because the initial infection is asymptomatic in over 80% of exposures. Fortunately, the majority of those chronically infected will develop mild liver disease and never progress to end-stage disease; however, a certain percentage will develop cirrhosis and may suffer with significant health problems secondary to hepatitis.