What’s the Outlook and Life Expectancy for Hepatitis C?

Complications from untreated hepatitis C, including cirrhosis (liver scarring) and liver cancer, can be fatal, though HCV itself is rarely fatal.

According to the Centers for Disease Control and Prevention (CDC), people who develop cirrhosis from HCV have a 1 to 4 percent chance of also developing liver cancer, and a 5 to 25 percent chance of developing cirrhosis within 20 years.

Hepatic decompensation (deterioration in liver function) and liver failure are also possible complications.

The outlook and life expectancy for people with chronic hepatitis C depends on how much of their liver is damaged. It also depends on how well a person responds to treatment.

But treatments have come a long way in recent years. Outlooks are often optimistic, especially with early intervention.

The CDC estimates that more than half of people with an HCV infection will develop chronic hepatitis C. Chronic hepatitis C is long term and can lead to permanent cirrhosis or liver cancer.

Chronic hepatitis C usually has no symptoms. People with chronic hepatitis C may not even know they have it. But once symptoms appear, it means that damage to the liver has already begun.

Treatment

Chronic hepatitis C is often treatable. It usually involves taking a combination of medications to reduce the viral load to undetectable levels. These drugs work to keep the virus from multiplying and eventually kill off the virus.

Drug regimens for hepatitis C are always changing and getting better. Talk to your doctor about the latest treatments to see if they might work for you.

After treatment, your doctor will make sure the virus is gone. Being clear of the virus, also called sustained virologic response (SVR), means it will likely not come back. But reinfection is still possible.

In the United States, older drug regimens included interferon injection and ribavirin, an oral medication. Now, newer oral medications called direct-acting antivirals (DAAs) may be more effective and better tolerated.

More than 90 percent of cases can be cured with 8 to 12 weeks of therapy. This depends on the:

• DAA used
• HCV genotype
• viral load
• severity of liver damage before treatment

It’s important to include routine HCV screening for certain populations to identify infection before severe damage occurs. A delayed diagnosis can affect the treatment’s effectiveness.

Genotype

Treatment success for chronic hepatitis C also depends on the genotype of the virus. Genotypes are variations of the virus that have evolved over the years. Some genotypes may be more difficult to treat than others.

Currently, genotypes 1a, 1b, 2, and 3 are the most common HCV genotypes in the United States.

Cases of hepatitis C in the United States

The CDC reports that in 2018, a total of 15,713 U.S. death certificates had hepatitis C as an underlying or contributing cause of death. This is likely lower than the actual numbers since so many infections go undocumented.

Studies show that baby boomers (born between 1946 and 1964) are more likely than other groups to have been exposed to HCV. Most of them contracted infections between 1970 and 1990 during a peak of new infections.

And since people with an HCV infection might not show symptoms, they may unknowingly transmit the virus to others.

Today, the most common risk factor for hepatitis C in the United States is injection drug use.

Since an HCV infection can show no symptoms, the number of new cases is likely higher than reported, according to the CDC.

Hepatitis C can lead to cirrhosis, especially if left untreated. Without treatment, cirrhosis can lead to liver cancer and liver failure.

Treating cirrhosis and liver cancer typically requires a liver transplant. A transplant can cure both cancer and liver function impairment. But a transplant is only available for a small number of people.

A review of the impact of interferon therapy on HCV-related cancers concluded that the treatment is beneficial in the outlook of the disease.

In June 2016, the Food and Drug Administration (FDA) approved the combination medication Epclusa (sofosbuvir/velpatasvir). This is the first drug approved to treat six genotypes of hepatitis C. Treatment options and new drug regimens for hepatitis C are rapidly evolving.

In 2019, the FDA approved the antiviral drug Mavyret (glecaprevir/pibrentasvir) for an 8-week treatment period for all genotypes. This was 4 weeks shorter than most other treatments with similar results.

Instead of liver biopsies, newer imaging tests, magnetic resonance elastography (MRE), and transient elastography are now being used to measure the stiffness of the liver to determine the extent of the damage.

Vaccinations

As of 2020, researchers are still working on a vaccine. There’s currently no vaccination for hepatitis C.

The virus is unique because it has at least seven distinct forms and 67 subtypes. This variability and immunological challenges are hurdles to vaccine success.

The outlook for hepatitis C depends on the type of virus causing it. In many cases, people may not know they have acute hepatitis C, which in about half of cases clears on its own.

But for chronic hepatitis C, the outlook depends on a person’s overall health, the degree of liver damage, how soon treatment is received, and response to treatment.

Drug therapies for chronic hepatitis C can clear the virus, and newer therapies are frequently improving the success rates of these treatments. Overall, the outlook improves with early diagnosis.