Infection with the hepatitis C virus, or HCV, resolves without treatment in at least 15 percent of cases. Liver disease does not become chronic or lead to cirrhosis, liver cancer or extrahepatic complications. However, for up to 85 percent of those with HCV infection, damage to liver cells is progressive. Treatment with chemotherapy is not appropriate for everyone. Four million Americans have HCV infection, which is spread by blood-to-blood transmission and is responsible for up to 10,000 deaths a year, according to the American Liver Foundation.
Cirrhosis of the Liver
One in four people with chronic HCV infection will develop cirrhosis. In this condition, healthy liver tissue is replaced by non-functioning scar tissue, usually over a period of 20 years or more. Cirrhosis can be slowed but not reversed. There may be no symptoms in the early stages. As more scarring occurs and there is less liver tissue available to filter toxins, fats, excess hormones and old red blood cells, increased bile products cause jaundice, or yellow pigment in the eyes and skin and intense itching. There may be other skin changes like dryness, bruising and spider angiomas. Blood pressure becomes elevated. As ammonia builds up in the bloodstream, fatigue and mental confusion, or encephalopathy, occur. Distention of veins leading to the liver put pressure on veins in the throat resulting in a hoarse voice. Fluid seeps into tissues, collecting around the liver and in the legs, causing both to become swollen. Abdominal pain and nausea lead to loss of appetite and weight loss. Hormonal imbalance causes impotence and abnormal gender-based characteristics. As the failing liver loses its ability to process protein, blood vessels hemorrhage, or bleed into the esophagus and stomach. The protein-rich blood further damages the liver in a cycle that ultimately ends in coma and death.
Liver Cancer
Liver cancer can be linked to cirrhosis in over 80 percent of cases, according to the National Liver Foundation. HCV infection is the second leading cause of cirrhosis. The growth of malignant tumors that begins in the liver is called hepatocellular carcinoma. Early detection is difficult because there are often no warning signs until late stages of the disease, and symptoms are very similar to those of cirrhosis. Blood tests, imaging and biopsy are diagnostic. Chemotherapy, surgery, radiation and liver transplant are currently the only treatment options.
Extrahepatic Complications
HCV infection may also lead to complications outside the liver. Such complications are rare, in the range of 1 to 2 percent, according to information provided by the National Digestive Diseases Information Clearinghouse. Cryoglobulinemia is a systemic inflammation characterized by a rash of tiny bruises, joint and muscle aches, nerve pain and kidney disease. Glomerulonephritis is the name for damage to the fluid and waste filtering tissues of the kidneys.
In Porphyria cutanea tarda, or PCT, HCV infection causes an enzyme deficiency from the build up of chemicals known as porphyrins in the liver. This condition manifests as blisters and peeling on sun-exposed skin such as the hands and face, increased hair growth, and sometimes darkening and thickening of the skin. According to the American Porphyria Foundation, as many as 80 percent of those afflicted with PCT also have hepatitis C.
