Hepatitis C can lead to cirrhosis, liver disease, or liver cancer if a person does not seek treatment. A liver biopsy can tell doctors how badly the liver is damaged and help them prescribe treatments to manage the condition.

Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). The World Health Organization (WHO) estimates that 58 million people worldwide have a chronic hepatitis C infection, which causes inflammation of the liver.

For about 30% of people with HCV, the illness is short-lived, and the body clears the virus within 6 months of infection. The remaining 70% develop an ongoing (chronic) HCV infection.

In this article, we look at how HCV damages the liver and the tests that doctors may prescribe to diagnose the condition. We will also explain what will happen during a liver biopsy and what the results mean.

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Over time, untreated HCV can cause permanent damage to the liver. According to an article published in Medicina Universitaria in 2017, HCV infection is most commonly associated with fibrosis, cirrhosis, and hepatocellular carcinoma, which is a type of liver cancer.

In medical terms, fibrosis means scarring. If the scarring is unchecked, it can lead to cirrhosis, a condition in which the scar tissue stops the liver from functioning correctly.

A liver biopsy can help doctors to determine the extent of the liver damage from HCV.

Learn more about liver fibrosis here.

Signs of hepatitis C

Most people with HCV do not experience specific symptoms, but may feel generally tired or depressed.

The U.S. Department of Health and Human Services estimates that more than half of the people with chronic HCV are unaware they have the condition and do not seek medical treatment.

Learn more about the possible signs and symptoms of hepatitis C here.

A liver biopsy is a medical procedure where a surgeon removes a sample of liver tissue for microscopic examination.

There are three types of liver biopsy:

  • Percutaneous: Doctors insert a hollow needle through the abdomen into the liver to obtain a tissue sample.
  • Transvenous: Doctors feed a hollow tube through the jugular vein to the liver via a small cut in the neck.
  • Laparoscopic: Doctors make a small incision, then use it to feed a tiny video camera in a tube into the body to see the organs. They can then choose where to insert the needle to obtain the sample.

Most people have a percutaneous biopsy, but doctors may recommend a transvenous one if the person has problems with blood clotting or has a buildup of fluid in the abdomen.

What happens during a percutaneous biopsy?

Before this medical procedure, a doctor will explain what is going to happen and talk about any risks involved. A person needing a liver biopsy should tell the doctor about any prescribed and over-the-counter medicines or supplements they are taking, as they may need to stop taking them before the procedure.

For the procedure itself, the person lies face-up on the bed, with their right arm above their head. After administering a local anesthetic to the appropriate area, the doctor will make a small cut to the skin and insert the biopsy needle.

Doctors take the tissue sample as the person exhales. So the doctor may ask them to breathe out and hold their breath.

Once the doctor removes the needle, they apply pressure to the wound and ask the person to lie on their right-hand side for up to 2 hours. Medical staff will continue to monitor the person and check for signs of bleeding for at least another 2 hours.

The main goal of a liver biopsy is to establish how much of the liver is damaged and how urgent treatment should be.

If fibrosis is at an early stage, treatment can help reverse its effects. But if the scarring is severe and doctors diagnose cirrhosis, the damage is most likely permanent. In the United States, HCV infection is the most common reason someone needs a liver transplant.

Learn more about liver cirrhosis here.

The sooner a person receives a diagnosis of HCV, the sooner they can start crucial treatment.

Doctors can detect HCV infection using a blood test called an HCV antibody test. If someone has a positive test result for HCV antibodies, they will need another blood test, called a nucleic acid test for HCV RNA, to establish if the virus is active.

Doctors usually prescribe direct-acting antivirals to people with active HCV. The Centers for Disease Control and Prevention (CDC) estimate that 90% of people who take the pills for the recommended course of 8–12 weeks will no longer have the condition.

While the direct-acting antivirals can cure HCV infection, they cannot cure liver damage. About 20% of people with an active HCV infection go on to develop cirrhosis within 20 years.

Learn about late-stage hepatitis C here.

Once doctors have established that a person has HCV, they may recommend other tests, including tests for hepatitis A and B and tests to determine the HCV genotype.

Other tests, such as liver function tests and imaging tests, including MRI and ultrasound, can help doctors understand the extent of liver scarring.

HCV can cause liver damage, including scarring, liver disease, or liver cancer. The likelihood of a more serious complication from HCV increases if a person does not seek treatment. But because HCV is usually symptom-free, people may not realize they have the condition at all.

A liver biopsy can help doctors determine the extent of the liver damage in a person with HCV. This way, they can start treatment as soon as possible.