Complications of Hepatitis C

Reviewed by: HU Medical Review Board | Last reviewed: February 2022

Over time, the hepatitis C virus (HCV) can cause many different health issues. More than half of all people with HCV will develop a chronic (long-term) infection. Because HCV reproduces in the liver, many of the issues people with HCV experience are liver-related.

HCV may also cause issues outside of the liver. These are called extrahepatic manifestations (“extra” meaning outside and “hepatic” meaning liver). In one study, 38 percent of people with HCV had symptoms outside the liver.1,2

Liver-related complications of HCV

Some of the most common HCV complications are caused by damage and scarring to the liver over time. Scarring that is not reversible is called cirrhosis. Cirrhosis can increase the risk of developing liver cancer (hepatocellular carcinoma).1

Cirrhosis can also lead to a buildup of toxins that impacts brain functioning. When this happens, it is called hepatic encephalopathy. Hepatic encephalopathy can cause:1,3

  • Irritability and other mood changes
  • Memory problems
  • Poor judgment
  • Coma

Cirrhosis can also lead to portal hypertension. Blood in the body flows through the liver. The liver’s blood vessels are called the portal system. When the liver is scarred, blood cannot flow as easily.

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This can lead to a backup that causes other symptoms, such as:1

  • Ascites (fluid buildup in the belly)
  • Varices (enlarged blood vessels) that can cause bleeding

Blood disorders

Chronic HCV can increase the risk for several blood-related issues. One of these is cryoglobulinemia. This is when small proteins clump together and block tiny blood vessels. The clumps can also deposit into the joints or other areas of the body. Among other complications, cryoglobulinemia can cause:2,3

  • Areas of purple-red skin bumps (called purpura or petechiae)
  • Joint pain
  • Kidney issues
  • Nerve problems

HCV may also impact the production of white blood cells. White blood cells are involved in the body’s infection-fighting response. One type of white blood cell called B lymphocytes may be affected. Some people with HCV develop a type of cancer called lymphoma.2,3

Autoimmune conditions

Autoimmune issues occur when the body’s immune system mistakenly attacks itself. Some autoimmune conditions are common with HCV. Conditions that people with HCV may be at increased risk for include:2,3

  • Sjögren syndrome or sicca syndrome (drying out of the mouth and eyes)
  • Rheumatoid arthritis
  • Lupus
  • Polyarteritis nodosa (inflammation of the blood vessels)
  • Antiphospholipid syndrome (causing issues with blood clots)
  • Thyroid problems

The exact reason why people with HCV may have a higher risk of developing these conditions is unknown.2,3


People with HCV are thought to be at an increased risk for developing type 2 diabetes (T2D). This may be related to changes HCV causes, but scientists are not sure. Risk factors for T2D that people with HCV may have include:2,3

  • Obesity
  • Older age
  • Liver problems or cirrhosis
  • Past liver transplant
  • Family history of T2D

Heart issues

In some cases, people with HCV may have a higher risk of developing cardiovascular (heart) issues. Like with autoimmune conditions, the exact cause is unclear. It may be related to HCV itself or to other risk factors. Some of the heart problems that people with HCV are more likely to experience are:2,3

  • Heart attack
  • Inflammation of the heart (myocarditis)
  • Heart failure

Skin problems

HCV can cause other skin issues besides the purple-red skin bumps already mentioned. People with HCV have a higher risk for a skin condition called porphyria cutanea tarda (PCT). PCT is caused by changes in the way the body processes and breaks down blood cells. It can lead to skin blistering or extreme sun sensitivity.2

Another skin condition that often comes along with HCV is lichen planus (LP). People with LP have purple, itchy spots on their skin. The spots can also affect the nails and mucus membranes (like the lips or mouth). There are other skin-related symptoms that can come along with HCV. These include itching or skin yellowing as a result of liver problems.2

Other common issues

In addition to the complications mentioned, there are other issues that may occur with chronic HCV. Some of these issues may be related to the complications listed above or occur on their own. They include:1-3

If you have chronic HCV and are concerned about complications, talk with your doctor. The doctor can help determine what issues you might be at risk for and how to best monitor for them.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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