Hepatitis C is a viral infection of the liver. If untreated, it may damage your liver over time and lead to cirrhosis or cancer. Hepatitis C usually doesn’t cause any symptoms until advanced stages.

Chronic hepatitis C can cause a range of liver injuries, from mild inflammation to severe liver damage and cirrhosis.

End stage liver disease, or stage 4 hepatitis C, occurs when the viral infection has so severely scarred and damaged your liver that the organ cannot function properly.

The hepatitis C virus (HCV) is transmitted through direct contact with blood that contains the virus.

Common ways of transmitting the virus include sharing needles, needlesticks, sharing a razor or other personal item with someone who has the disease, or having received blood or blood products prior to 1992.

If you’re pregnant and you have hepatitis C, your newborn baby can contract HCV from you at the time of birth. It’s extremely rare to come into contact with HCV during sexual activity unless blood and open wounds are present.

Not everyone who lives with hepatitis C will experience the disease in the same way. It’s estimated that about 15% to 25% of people who have contracted HCV will clear the virus from their body without treatment, according to the American Liver Foundation. Those who do not clear the virus will develop chronic hepatitis C.

Without treatment, some people will progress to end stage liver disease within a few years. Still, others may not develop significant liver damage until decades later.

The hepatitis C virus attacks your liver. Your immune system releases inflammatory substances in response. These substances stimulate your liver to produce fibrous proteins like collagen to repair the damage. Collagen and other proteins can build up within the liver. This creates scar tissue.

Scar tissue buildup in your liver is called fibrosis. It can prevent blood from flowing to your liver cells and change the functioning of your liver. Over time, the liver cells die causing the liver to no longer function properly.

The METAVIR score is one method used to measure fibrosis in people with hepatitis C. Scoring is divided into five stages:

  • stage 0: no fibrosis
  • stage 1: mild fibrosis without walls of scarring
  • stage 2: mild to moderate fibrosis with walls of scarring
  • stage 3: bridging fibrosis or scarring that has spread to different parts of the liver but no cirrhosis
  • stage 4: severe scarring, or cirrhosis

The first 6 months of hepatitis C is called the acute or short-term phase.

Most people who have recently contracted HCV do not have any symptoms. But some people do develop symptoms. They may experience:

  • abdominal pain
  • appetite loss
  • dark urine
  • fatigue
  • fever
  • gray-colored stools
  • joint pain
  • nausea
  • vomiting
  • a yellowing of the skin and whites of the eyes called jaundice, which is a sign that the liver is not working properly

In about 30% of people, the immune system destroys the virus during this phase. Most people with hepatitis C progress to the chronic phase.

After 6 months, most people with hepatitis C move into the chronic phase of the disease. This means the body was not able to build an effective immune response against the virus, which leads to long-term infection.

Most people still do not have any symptoms during the chronic phase. Often, people are not diagnosed until they’re screened or until their doctor detects high levels of liver enzymes during a routine blood test.

Without treatment for chronic hepatitis C, scar tissue replaces normal liver tissue. As damage continues, the body can no longer keep up with the failing liver. This is considered end stage liver disease, or ACLD (advanced chronic liver disease).

At first, the body does its best to compensate for poor liver function. But over time, the liver becomes so scarred that it does not work properly. It’s no longer able to perform its vital bodily functions.

People with cirrhosis can develop complications, such as:

  • easy bruising and bleeding
  • confusion
  • fatigue
  • infections
  • unexplained itchiness
  • jaundice
  • loss of appetite
  • nausea
  • swelling in the legs and abdomen
  • weight loss

Both hepatitis C and cirrhosis increase your risk of liver cancer.

If hepatitis C is recognized and diagnosed in the acute phase, treatment should begin right away, unless the individual is pregnant or younger than 3 years old, according to the Centers for Disease Control and Prevention.

Others usually follow up with a hepatitis C specialist to monitor their liver function and see if the virus clears on its own. Those who clear the virus do not need treatment. Those who do not clear the virus after 6 months will typically begin treatment.

The same medications that are used for treating chronic hepatitis C are also used to treat individuals early on in the acute phase.

Once chronic hepatitis C is diagnosed, treatment is typically recommended. Treatment can stop or even reverse fibrosis and protect against further liver damage.

A liver biopsy involves removing a piece of the liver for testing. This can help your doctor see how much damage your liver has experienced.

Which drug, or combination of drugs, you’re prescribed depends on:

  • any ongoing health issues
  • how much your liver has been damaged
  • which of the hepatitis C virus strains you have
  • whether your type of hepatitis C is resistant to any medication

Currently, researchers have identified at least six types of HCV.

Pegylated interferon injections used to be the main treatment for hepatitis C. Oral antiviral drugs are now typically used in combination instead of interferon. Some combination medications include:

  • Harvoni (ledipasvir/sofosbuvir)
  • Zepatier (elbasvir/grazoprevir)
  • Technivie (ombitasvir/paritaprevir/ritonavir)

The following recently introduced medications are approved to treat all six types of HCV:

  • Epclusa (sofosbuvir/velpatasvir)
  • Vosevi (sofosbuvir/velpatasvir/voxilaprevir)
  • Mavyret (glecaprevir/pibrentasvir)

The treatment goal is to have a sustained virological response (SVR). This means your doctor cannot detect any HCV in your blood 12 weeks after completing treatment via testing methods. With new hepatitis C drugs, the disease is curable in 90% or more of cases.

When the disease reaches end stage, it cannot be reversed. But you can take medication to manage symptoms like fatigue, pain, and itching. If your liver stops working, a liver transplant is needed.

If you’ve been diagnosed with hepatitis C, you’ll see a hepatologist. A hepatologist is a doctor who specializes in liver diseases. Your hepatologist will evaluate any liver damage and discuss your treatment options.

It’s important to get treated as soon as possible. New medications that have been introduced in recent years can cure hepatitis C and prevent liver complications in most people.

Along with taking prescribed medications, you can consider talking with your healthcare team about other steps you can take to protect your liver as well as your overall health and wellness. Avoiding alcohol and other medications that affect the liver may be recommended as well.

Can stage 4 hepatitis C be cured?

While stage 4 hepatitis C can be managed via medications, it cannot be cured. If your liver stops working, the only cure is a liver transplant.

What are the final stages of hepatitis C?

The final stages of hepatitis C are cirrhosis and liver failure. Both conditions can increase your risk of liver cancer.

Does hepatitis C shorten your life?

Hepatitis C can shorten your life if it’s not treated as soon as possible.

Once hepatitis C reaches the end stage, it cannot be reversed, which means you’re more likely to develop advanced chronic liver disease, cirrhosis, or liver cancer.

Are there levels of hepatitis C?

Yes, the main levels of hepatitis C are the short-term or acute phase and the long-term or chronic phase.

If you’re diagnosed with hepatitis C, it’s important to start treatment as soon as possible.