Hepatitis C is a viral infection of the liver. When a person has the hepatitis C virus (HCV) for several years, their liver can become inflamed. However, a person can live for years without even knowing that they have HCV. Once the symptoms start to show, the person usually already has liver damage, which can affect treatment and prognosis.
There are two main types of HCV: acute and chronic. Around 75–85% of acute cases become chronic. The immune system clears most other cases.
There are also different genotypes, or variations, of the virus. These strains of the virus have evolved over many years.
A person will usually discover that they have HCV either after a blood test or because symptoms of liver damage have started to appear. The symptoms of liver damage tend to appear when a person has had chronic HCV for many years.
Chronic HCV needs treatment to prevent liver damage and other complications. Liver damage and scarring can have an impact on a person's overall prognosis and life expectancy.
Keep reading to learn more about the prognosis of different forms of HCV, as well as a person's likely life expectancy.
For some people whose immune systems can clear it, acute HCV is a short-lived viral infection. The sections below cover the possible symptoms and outlook of acute HCV.
Acute HCV usually produces no symptoms. If symptoms do occur in acute HCV, however, they may include:
- abdominal pain
- loss of appetite
- dark urine
- jaundice, or yellowing of the skin and eyes
- clay-colored bowel movements
- joint pain
People with acute HCV may not require any direct treatment. However, about 75–85% of people with an acute HCV infection may eventually develop a chronic HCV infection.
If a doctor is able to detect and diagnose acute HCV infection early, they will be able monitor it. Unless it develops into chronic HCV, there is very little risk of death from acute HCV.
That said, acute HCV will develop into chronic HCV if the body does not spontaneously clear the virus within 6 months of infection.
For people with HCV who receive a diagnosis before any liver damage or scarring occurs, the prognosis will tend to be better than for people who receive a diagnosis after scarring or liver damage has already occurred.
The Centers for Disease Control and Prevention (CDC) suggest that people undergo testing for HCV, especially if they were born between 1945 and 1965, have used injectable drugs, or have other potential risk factors.
Detecting and diagnosing the infection early may allow the person to treat it before liver damage or scarring can occur.
The majority of people with chronic HCV will display no symptoms until decades after infection, unless other complications develop.
Some potential complications of chronic HCV include:
Treatment will vary based on the genotype of the virus and the presence of any other health conditions a person has. Treatments are continually improving, making it possible for a person to live an active and normal life with HCV.
Following treatment, a person's doctor will often check again for the viral load, or the amount of virus, in their blood. Treatment usually completely rids the body of the virus.
In other cases, a person may need to change their medications to better treat the virus.
In the United States, typical treatments for HCV used to include interferon, which is an injection, and ribavirin, which is an oral medication. However, newer medications called direct-acting antivirals (DAAs) are starting to make the treatment process shorter and more effective.
Certain DAAs can target specific genotypes of HCV. Targeted treatments can help improve the outcome for some people.
The prognosis of chronic HCV is typically very good, and as treatment continues to improve, it will only get better. Most people with chronic HCV can live a normal life, providing that doctors are able to diagnose it before any liver damage or other complications occur.
According to the CDC, around 10–20% of people with chronic untreated HCV will eventually develop cirrhosis. Cirrhosis is a condition in which scarring occurs on the liver.
Cirrhosis can cause symptoms such as:
- bruising and bleeding easily
- swelling in the lower legs, ankles, or feet
- difficulty thinking
- memory loss
- personality changes
- sleep disorders
- ascites, or bloating from a buildup of fluid in the abdomen
- severe itchy skin
- dark urine
Treatment for living scarring or damage tends to involve treating both the virus and the liver. For people with end stage cirrhosis due to chronic HCV, the best treatment option is a liver transplant.
A liver transplant can correct both liver damage and liver cancer. However, only a small number of liver transplants are available.
Cirrhosis may develop faster in certain groups of people. The following factors can increase the speed at which cirrhosis advances:
- sex (males have a higher risk than females)
- the presence of nonalcoholic fatty liver disease
- age (people over the age of 50 have a higher risk)
- alcohol consumption
- hepatitis B or HIV coinfection
- immunosuppressive therapy
According to the CDC, people who develop cirrhosis from HCV have a 1–5% chance of developing liver cancer. They also have a 3–6% annual chance of developing hepatic decompensation and liver failure.
Hepatic decompensation occurs when a person with cirrhosis begins to show symptoms of the condition because the liver is having trouble functioning. People who develop hepatic decompensation have a 15–20% risk of death the following year.
The CDC report that in 2017, 17,253 deaths in the U.S. had HCV listed as a contributing factor. More than 70% of these deaths also had moderate-to-severe liver disease listed as a cause.
These statistics enforce the notion that HCV alone will rarely lead to death. It is the complications that develop over many decades of living with the virus that tend to lead to death. The average age of these HCV-related deaths was 59.
It is also important to note that the CDC explain that the number of deaths may be a little low because of incorrectly reported conditions on death certificates.
The prognosis for HCV depends on how quickly a doctor is able to diagnose and start treating it. Early detection from blood screenings can help.
People with a higher risk of contracting HCV should talk to their doctor about screening. In the U.S., this includes people who use recreational injected drugs, those born between 1945 and 1965, and healthcare workers.
If a person already has liver damage or scarring before treatment begins, the prognosis is generally worse than in those who do not have liver damage.
People who die from HCV usually die as a result of complications, such as liver damage or liver failure.