Chronic hepatitis C sneaks up on you slowly, which makes it particularly dangerous. Hepatitis C virus, or HCV, infection typically persists for a decade or longer without causing liver-specific symptoms. During this “silent” period of the illness, however, HCV steadily attacks and damages your liver. In the wake of this damage, scar tissue accumulates in your liver that can eventually lead to complications like cirrhosis, liver failure and liver cancer. Immune system abnormalities can also develop, which may lead to illnesses outside your liver.
While hepatitis C complications are serious, they are not inevitable. Clearing HCV from your body with antiviral treatment reduces the risk for all of the long-term complications of hepatitis C.
As many as one out of five people with untreated hepatitis C will eventually develop cirrhosis within 20 to 30 years, according to the Centers for Disease Control and Prevention. With cirrhosis, scarring due to HCV infection distorts normally smooth liver tissue into cobblestone-like nodules. The heavily scarred tissue slows blood flow through the liver, causing a backup in the veins of the digestive system. Most people with early-stage cirrhosis have only vague symptoms, such as tiredness, a poor appetite or mild pain in the right upper abdomen — and some people are symptom-free. Symptoms often remain sparse because the liver manages to keep up with the body’s needs despite the damage it has sustained.
Once cirrhosis develops, the course of untreated hepatitis C becomes a slippery slope. As scar tissue continues to accumulate, liver function can eventually decline to the point of liver failure. This transition invariably causes serious and often disabling liver-specific signs and symptoms, such as:
- yellowish staining of the skin and whites of the eyes
- decreased urination and swelling of the feet and legs
- accumulation of fluid in the abdomen
- episodes of vomiting blood
- declining mental function or personality changes
- tremors and poor coordination
HCV-related cirrhosis with liver failure is very serious, and specialized medical care is needed. Antiviral treatment may still be possible, but evaluation for a liver transplant is also typically recommended.
HCV is a cancer-causing virus. When you have HCV, your risk for liver cancer is nearly 12 times greater than for people who are not infected, according to the National Toxicology Program’s Report on Carcinogens, Thirteenth Edition. In fact, the National Cancer Institute states that HCV is the leading cause of liver cancer in the U.S. Liver cancer most commonly occurs in people with cirrhosis. Other factors that increase your risk for liver cancer with hepatitis C include:
- heavy drinking
- infection with HIV or the hepatitis B virus
- excess fat
- iron in the liver
Although HCV primarily infects and damages your liver, complicating conditions may also affect other organs and body systems. Many of these conditions develop due to specialized proteins called antibodies that are produced by your immune system to fight HCV. These antibodies are intended to bind specifically to HCV, but they sometimes wreak havoc by reacting with other proteins in the blood. This condition, known as cryoglobulinemia, can cause a host of problems, including:
- kidney damage
- numbness, tingling and pain due to nerve damage
- muscle and joint pain
- dry mouth and eyes
- skin rashes
Hepatitis C can also increase your risk for other conditions, including prediabetes, diabetes, kidney disease, depression, anxiety disorders and non-Hodgkin lymphoma — a type of cancer arising from immune system cells. Clearing HCV from the body prevents most of these conditions or helps alleviate them if they’ve already developed.
- Hepatitis C Online: Natural History of Hepatitis C Infection
- Centers for Disease Control and Prevention: Hepatitis C FAQs for Health Professionals
- Hepatitis C Online: Evaluation and Prognosis of Patients with Cirrhosis
- Cirrhosis: A Practical Guide to Management; Samuel S. Lee, M.D. and Richard Moreau, M.D.
- Journal of Hepatology: Natural History of Hepatitis C
- Merck Manual Professional Edition: Portosystemic Encephalopathy
- HCVGuidelines.org: Unique Patient Populations: Patients With Decompensated Cirrhosis
- Report on Carcinogens, 13th Edition; National Toxicology Program, U.S. Department of Health and Human Services
- National Cancer Institute: Adult Primary Liver Cancer Treatment – For Health Professionals (PDQ)
- Hepatitis C Online: Surveillance for Hepatocellular Carcinoma