According to the Centers for Disease Control and Prevention (CDC), an estimated three-and-a-half million people in the United States have a chronic hepatitis C infection. 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 five and 20 people will go on to develop cirrhosis, according to the CDC. 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 (bilirubin, albumin, coagulation parameters, etc.)
  • 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 (bacterial peritonitis)
  • combined kidney and liver failure (hepatorenal syndrome)

The presence of cirrhosis in HCV patients 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 those with HCV will develop cirrhosis. But, some patients with HCV are more likely to develop cirrhosis. Alcohol use can increase the risk, so anyone with chronic HCV infection should avoid alcohol.

Being infected with HCV and another virus (such as HIV or hepatitis B) can increase your risk for cirrhosis. High levels of iron in the blood can also increase your risk.

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

Cirrhosis Prognosis

If caught early, cirrhosis can have a good prognosis. Treating an HCV patient with interferon might help slow the progression of cirrhosis.

People with advanced, decompensated cirrhosis don’t have as good of an outlook. Ultimately, the only effective treatment for advanced cirrhosis is a liver transplant. HCV infection is the most common cause of liver transplant in the United States.

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 (varices) 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

Patients with early-stage cirrhosis can be treated with interferon and ribavirin. These medications may slow the progression of liver disease and liver failure. Even if the HCV cannot be completely cleared from your body, a long-term, low level of interferon may help delay complications of cirrhosis.

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 Doesn’t Have to Be the End

Patients can live for decades with cirrhosis, especially if it’s diagnosed early. To preserve liver health, maintain your general health, avoid alcohol, get regular medical care, and treat the underlying HCV infection. Work with a good gastroenterologist or hepatologist to find the best treatment and to monitor possible complications.