Over years, HCV infection can cause major damage to the liver. For every 75 to 85 people who have chronic HCV infection, between 5 and 20 of them will develop cirrhosis. HCV infection is the leading cause of cirrhosis and liver cancer.
The liver is an organ that detoxifies the blood and makes vital nutrients. There are many things that can damage the liver. Some of these include:
Over time, inflammation in the liver causes 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
- liver failure
There are two stages of cirrhosis:
There may be few symptoms after initial HCV infection. Many people with hepatitis C don’t even know they have the life-threatening disease.
HCV attacks the liver. Many people exposed develop a chronic infection after initial infection with HCV. Chronic HCV infection slowly causes inflammation and damage in the liver. Sometimes the condition may not be diagnosed for 20 or 30 years.
You may not have any symptoms of cirrhosis until there is considerable damage to your liver. When you experience symptoms, these may include:
- 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)
A liver biopsy will show scarring, which can confirm the presence of cirrhosis in people with HCV.
Lab tests and a physical exam may be enough for your doctor to diagnose advanced liver disease without a biopsy.
Less than a quarter of people with HCV will develop cirrhosis. But, certain factors can increase your risk of cirrhosis, including:
- alcohol use
- infection with HCV and another virus (such as HIV or hepatitis B)
- high levels of iron in the blood
Anyone with chronic HCV infection should avoid alcohol. Cirrhosis can also accelerate in people older than 45 as fibrosis and scarring increase. Aggressively treating HCV infection in younger people may help prevent progression to cirrhosis.
It’s important to stay healthy if you have cirrhosis. Be sure to keep all immunizations up to date, including:
- hepatitis B
- hepatitis A
Cirrhosis can change the way blood flows through your body. 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 cancer. Other complications of cirrhosis include:
Highly effective, direct-acting antivirals and other HCV medications can treat early-stage cirrhosis. These medications may slow the progression of liver disease and liver failure.
When cirrhosis becomes advanced, treatment becomes more difficult due to complications like:
These complications can make it unsafe to use some medications. A liver transplant may be the only treatment option.
A liver transplant is the only effective cure for advanced cirrhosis. Most people who receive a liver transplant for hepatitis C survive for at least five years after the transplant. But, HCV infection usually returns. It’s the most common cause of liver transplant in the United States.
People with cirrhosis can live for decades, especially if it’s diagnosed early and managed well.
About 5 to 20 percent of people with chronic hepatitis C will develop cirrhosis. With that in mind, it takes about 20 to 30 years for cirrhosis to develop in that population.
Using direct-acting antivirals might help slow or prevent the progression to cirrhosis. If left untreated, cirrhosis can lead to liver failure.
To preserve liver health, try the following:
- maintain general health
- avoid alcohol
- get regular medical care
- treat the underlying HCV infection