Hepatitis C is a bloodborne virus that affects the liver. Following infection, a small number of people can spontaneously clear the virus. However, others develop chronic hepatitis C. Without treatment, the infection might lead to advanced liver disease and even hepatic coma.

Many people with chronic hepatitis C do not know that they have an infection until it shows on a routine blood test. It may not cause any symptoms, and people may live with an infection for decades before they receive a diagnosis.

Although chronic hepatitis C can cause serious liver complications, doctors can successfully treat it with antiviral medication. This prevents further damage to the liver, cures the infection, and prevents its spread.

However, if people do not seek treatment, they may develop complications that lead to a disorder called hepatic encephalopathy. They may even fall into a hepatic coma.

Keep reading to learn more about chronic hepatitis C, including the complications that might lead to hepatic coma and how doctors treat hepatitis C when hepatic coma is not present.

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Hepatitis C is a virus that damages the liver. Doctors classify it as acute or chronic according to how long it inflames and damages the liver.

Acute hepatitis C lasts for less than 6 months and goes away on its own. About 10–15% of people with an HCV infection experience this type.

Conversely, chronic hepatitis C is a long-term infection that can last for years and cause serious liver damage. Approximately 20% of people with chronic hepatitis C infections develop cirrhosis within 20 years, and 1–5% develop liver cancer within 30 years.

People with hepatitis C may have no symptoms initially. However, they may develop chronic liver disease after years of infection. If symptoms do occur, they may include the following:

  • abdominal and joint pain
  • dark urine
  • decreased appetite
  • fever
  • nausea and vomiting
  • yellowing of the skin and the whites of the eyes

Diagnosis

People may not know that they have hepatitis C until they have a routine blood test or develop liver problems. When diagnosing hepatitis C, doctors use a blood test that looks for antibodies to the hepatitis C virus. However, following infection, it can take some time for the immune system to make antibodies. This means that a person might not have a positive reaction initially.

A positive test shows that a person has had a hepatitis C infection at some point, but it does not necessarily mean that they have an infection currently. Therefore, doctors may also use a PCR blood test to see whether the virus is still present in the body.

Hepatic encephalopathy is a brain and nervous system disorder that can develop in some individuals with hepatitis C. It happens because the liver is not functioning properly, so toxins build up in the blood and affect brain function.

About 70% of individuals with liver cirrhosis may develop symptoms of hepatic encephalopathy.

A person with hepatic encephalopathy may appear confused and have difficulty thinking. The symptoms can vary a lot from person to person, and they can even be life threatening.

There are five stages of hepatic encephalopathy, and each stage is more progressive than the one preceding it.

Some people with advanced hepatic encephalopathy may lose consciousness and fall into a hepatic coma. This is characteristic of the last stage of hepatic encephalopathy.

However, hepatic encephalopathy may not always lead to hepatic coma, especially if doctors treat the condition and the underlying cause of it early enough.

The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) system is a classification system that healthcare professionals use for medical diagnoses. It assigns alphanumeric codes to health conditions.

The assigned code can help track public health conditions, billing, and processing claims. Some codes for chronic viral hepatitis and hepatic coma are as follows:

  • B18.2 — chronic viral hepatitis C
  • B19.21 — unspecified viral hepatitis C without hepatic coma
  • K72.10 — chronic hepatic failure without coma
  • K72.11 — chronic hepatic failure with coma

Healthcare professionals may use multiple codes in certain instances. For example, they may give someone with chronic hepatitis C and hepatic encephalopathy the following codes: B18.2 and K72.10. Hepatitis C can lead to liver failure and hepatic encephalopathy, a condition that can occur with or without coma. As coma does not occur in all cases of hepatic encephalopathy, other codes may not be appropriate.

Doctors may prescribe a single drug or a combination of antiviral medicines to treat the chronic hepatitis C infection:

  • daclatasvir (Daklinza)
  • elbasvir/grazoprevir (Zepatier)
  • ledipasvir/sofosbuvir (Harvoni)
  • ombitasvir/paritaprevir/ritonavir/dasabuvir (Viekira Pak, Viekira XR)
  • ribavirin (Virazole)
  • peginterferon alfa-2a or alfa-2b

The course of treatment may last 2–6 months, although this depends on the extent of a person’s liver damage and the specific genetics of the hepatitis C virus.

Throughout treatment, doctors monitor the individual by using blood tests to ensure that the treatment is working. These antiviral medications usually cure the hepatitis C infection, as long as the individual completes the treatment.

Without treatment, chronic hepatitis C infection can cause liver complications, such as hepatic encephalopathy and even hepatic coma. People should note that the treatment course for people with chronic hepatitis C with hepatic coma may be different.

Besides hepatic coma, the possible complications of chronic hepatitis C infection include:

  • Cirrhosis of the liver: Scarring of the liver is the most common complication of hepatitis C. After many years of hepatitis C infection, the liver breaks down and does not function as it should. Scar tissue replaces healthy tissue and blocks normal blood flow through the liver. As cirrhosis worsens, the liver begins to fail.
  • Liver failure: As cirrhosis advances, the liver may be unable to replace damaged cells, and it can fail entirely. Doctors may also refer to liver failure as end stage liver disease.
  • Liver cancer: Living with hepatitis C increases the risk of liver cancer. If an individual has severe liver damage before receiving treatment, the increased risk of liver cancer remains.

Additionally, some individuals with chronic HCV infection develop complications unrelated to the liver, including:

Receiving a diagnosis of hepatitis C may feel overwhelming, but with proper treatment, most people fully recover.

In the meantime, people should take steps to prevent the spread of the infection. These include:

  • avoiding sharing needles, medical equipment, toothbrushes, razors, or anything else that might have contacted infected blood
  • covering wounds with bandages
  • cleaning up blood spills with a bleach solution
  • washing the hands after touching wounds or blood
  • informing doctors, dentists, and other healthcare professionals of their hepatitis C status
  • avoiding sexual activities where blood is present

Chronic hepatitis C is a serious infection that can lead to cirrhosis, liver damage, and liver cancer. In some cases, it can also cause other complications, including hepatic coma, diabetes, and non-Hodgkin lymphoma.

Typically, treatment with antiviral medication for 2–6 months successfully cures the infection and prevents further liver damage. While they are receiving treatment, people with chronic hepatitis C should take measures to prevent the spread of the virus.