Hepatitis C can lead to cirrhosis

An estimated 3.5 million people in the United States have a chronic hepatitis C infection. Yet most people infected with the hepatitis C virus (HCV) don’t even know they have it.

Over the course of years, HCV infection can cause major damage to the liver. For every 100 people with chronic HCV infection, between 5 and 20 people will go on to develop cirrhosis. In fact, HCV infection is the leading cause of cirrhosis and liver cancer.

Hepatitis C can be invisible

The initial HCV infection may result in very few symptoms. It’s not surprising that many people with hepatitis C don’t know they have a life-threatening disease.

HCV attacks the liver, and after initial infection, many people exposed develop a chronic infection. Chronic HCV infection slowly causes inflammation and damage in the liver. It may take 20 or 30 years before enough damage is done for the problem to be found.

Cirrhosis, scars of a lifetime

The liver is a crucial organ that detoxifies the blood and makes vital nutrients. Damage to the liver can occur from chronic alcohol abuse, parasites, and many other causes, including hepatitis.

Over time, inflammation in the liver results in scarring and permanent damage called cirrhosis. At the point of cirrhosis, the liver is unable to heal itself. Cirrhosis can lead to end-stage liver disease, liver cancer, and liver failure. If a person has any of these conditions, they may need a liver transplant.

There are two stages of cirrhosis: compensated and decompensated. Compensated cirrhosis means the body still functions despite reduced liver function and scarring. Decompensated cirrhosis means that body functions are breaking down. In decompensated cirrhosis, serious symptoms may occur, including kidney failure, variceal hemorrhage, and hepatic encephalopathy.

Symptoms of cirrhosis due to hepatitis C

You may not have any signs or symptoms of cirrhosis until it has done considerable damage to your liver. Symptoms of cirrhosis include:

  • fatigue
  • nausea
  • loss of appetite
  • weight loss
  • bleeding or bruising easily
  • itchy skin
  • yellow discoloration in eyes and skin (jaundice)
  • swelling in legs
  • fluid in abdomen (ascites)
  • abnormal blood tests, such as bilirubin, albumin, and coagulation parameters
  • enlarged veins in the esophagus and upper stomach that may bleed (variceal hemorrhage)
  • impaired mental function due to buildup of toxins (hepatic encephalopathy)
  • infection of the abdominal lining and ascites (bacterial peritonitis)
  • combined kidney and liver failure (hepatorenal syndrome)

The presence of cirrhosis in people with HCV is confirmed when a liver biopsy shows scarring. Lab tests and a physical exam may be enough to diagnose an advanced case of liver disease without a biopsy.

Progressing to cirrhosis

Less than a quarter of people with HCV will develop cirrhosis. However, certain factors can increase your risk of cirrhosis, including:

  • alcohol use
  • being infected with HCV and another virus (such as HIV or hepatitis B)
  • having high levels of iron in the blood

Anyone with chronic HCV infection should avoid alcohol.

Cirrhosis can also accelerate after age 45, as fibrosis and scarring increase. Aggressively treating HCV infection in younger people may help prevent progression to cirrhosis.

Cirrhosis complications

It’s important to stay as healthy as possible if you have cirrhosis. Be sure to keep all immunizations up to date, including hepatitis B, hepatitis A, influenza, and pneumonia.

Cirrhosis can change the way blood flows through your body. The scarring may block blood flow through the liver. Blood might shunt through large vessels in the stomach and esophagus. These blood vessels can enlarge and rupture, causing bleeding into the stomach. Make sure to watch for abnormal bleeding.

Liver cancer is another possible complication of cirrhosis. Your doctor may use ultrasound and certain blood tests every few months to test for possible cancer. Other complications of cirrhosis include:

  • gingivitis or gum infections
  • diabetes
  • changes in how medications are processed in your body

HCV and cirrhosis treatments

People with early-stage cirrhosis can be treated with highly effective direct-acting antivirals, and additional HCV medications. These medications may slow the progression of liver disease and liver failure.

Once cirrhosis has become advanced, treatment becomes much more difficult due to complications like ascites, anemia, and encephalopathy. This can make it unsafe to administer certain medications. Liver transplantation may be the only possible treatment.

Cirrhosis prognosis

If caught early, cirrhosis can have a good outlook. People can live for decades with cirrhosis, especially if it’s diagnosed early. Treating an HCV patient with direct-acting antivirals might help slow the progression of cirrhosis.

To preserve liver health, maintain your general health, avoid alcohol, get regular medical care, and treat the underlying HCV infection. Work with a gastroenterologist or hepatologist to find the best treatment and to monitor possible complications.

The only effective treatment for advanced cirrhosis is a liver transplant. Most people who receive a liver transplant for hepatitis C survive for at least five years after the transplant. However, the HCV infection almost always returns. HCV infection is the most common cause of liver transplant in the United States.