Ask the Expert: What are the phases of hepatitis C?

Last updated: October 2020

Hepatitis C is a progressive disease that can have severe consequences if left untreated. You may have heard that there are multiple phases of hepatitis C, but it can be difficult to understand what these different phases mean. We asked our expert, Sue, to explain, and here's what she had to say!

Sue's Response:
SueSimon avatar

Hepatitis C: What is it?

Hepatitis means inflammation of the liver. Hepatitis C is a viral infection that causes inflammation that results in fibrosis, or scar tissue in the liver. This virus not only involves the liver, but it affects the patient’s entire body and may cause extra-hepatic manifestations such as kidney disease, issues with skin problems, cryoglobulinemia, vascular disease, insulin resistance and many other systemic health conditions.

When a person is exposed to the virus, his body will develop antibodies. Approximately 15-40% of patients have immune systems that fight off the disease in this acute stage without any treatment. The majority, however, progress to chronic hepatitis C which may last a lifetime unless treated. Once exposed, even when cured, the patient will have antibodies for life. Unfortunately these antibodies are not protective and if the person is exposed to the virus again, he may become infected all over again.

The acute and chronic phases

The acute phase of the illness is the first six months after exposure. It is usually symptom free although some patients complain of fatigue, loss of appetite and possibly mild jaundice. The majority of patients, anywhere between 60 and 85%, will go on to develop chronic infection. They may be symptomless until late stage disease develops. That is one of the reasons that hepatitis C is so insidious. The liver is silently being assaulted and unless the physician is looking for it, it can go unnoticed for a couple of decades, all the while damaging the patient’s liver.

The stages of liver disease

There are four main stages of liver disease in hepatitis C infected patients. Staging is determined by liver biopsy or other non-invasive tests such as fibrosure or fibroscan.

  1. Stage 1 – Mild inflammation
  2. Stage 2 - Mild to moderate fibrosis (scarring)
  3. Stage 3 - Bridging fibrosis
  4. Stage 4 - Cirrhosis

Once a person is diagnosed with cirrhosis, monitoring for hepatocellular carcinoma (HCC) should be done every six months. A blood test called alfa feto protein (AFP) and imaging with ultrasound and/or MRI, are the tools used. Approximately 20% of cirrhotic patients will eventually develop HCC. The risk falls to about 5% in patients who have successfully treated the virus and have a sustained viral response, better known as a cure.

It is important to determine if a person with cirrhosis has compensated or decompensated disease. In compensated cirrhosis, a person’s liver is working well enough to do its many functions and there are often no overt symptoms. When a person starts to decompensate, his prognosis is significantly worsened. Patients with decompensated cirrhosis have complications which may include jaundice, ascites, variceal hemorrhage, and encephalopathy. People with decompensated cirrhosis need to be followed by a hepatologist and evaluated for liver transplant.

The Child-Pugh Score is used along with the MELD score help the physician assess the prognosis of cirrhosis. I will discuss these scoring systems at a later time.1,2,3,4

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