Risk of Hepatitis C Progression

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

Hepatitis C virus (HCV) can show up in several forms or phases. These include acute (short-term) HCV, chronic (long-term) HCV, and end-stage HCV. The journey from acute HCV to chronic HCV to fibrosis, cirrhosis, and end-stage liver failure is often referred to as HCV getting worse or progressing.1,2

What does it mean for hepatitis C to progress?

HCV lives and reproduces in the liver. Over time, it causes damage. The liver is able to heal itself, but only to a certain extent. As damage continues happening, the liver has a hard time keeping up. This leads to scarring.2,3

Scarring that is reversible is called fibrosis. Eventually, scarring continues to the point that it cannot be reversed. This is called cirrhosis. Fibrosis and cirrhosis usually occur after many years of a person having HCV. Cirrhosis can cause liver failure or end-stage hepatitis C.2,3

Chances of spontaneous clearance

You must first have acute HCV before you progress to chronic HCV which can cause cirrhosis. About half of all people with acute HCV will clear the virus on their own (called “spontaneous clearance”).4

Spontaneous clearance is when your body fights off HCV without any formal treatment. Although everybody is different, there are factors that increase a person’s chance of spontaneous clearance. These include:4

  • Having symptoms with acute HCV (versus no symptoms)
  • Being younger
  • Having chronic or past hepatitis B infection
  • Having spontaneously cleared HCV in the past

These are not all of the factors that may increase the chances of spontaneous clearance. In addition, having one or more of these factors does not guarantee a person will clear the virus on their own. If you are concerned you may have come into contact with HCV, talk with your doctor about testing.

Factors that increase the risk of progression

Up to 30 percent of people with chronic HCV will progress to cirrhosis. As mentioned, this process can take many years. Sometimes a person will not know they have chronic HCV until their liver is severely damaged. Signs of liver problems may be the first symptoms they notice.1,3

Each person will have their own risk for developing cirrhosis. But similar to your chances of spontaneously clearing acute HCV, there are several things that may impact risk. Some of the factors that increase your risk for developing cirrhosis are:1,3

  • Being over 40 when you were exposed to HCV
  • Using alcohol
  • Being a man
  • Having a history of insulin resistance or diabetes
  • Having hepatitis B or HIV (human immunodeficiency virus) infections
  • Having nonalcoholic fatty liver disease
  • Taking certain drugs, like immunosuppressants (drugs that inhibit the immune system)
  • Having a greater level of inflammation or scarring of the liver at the time of diagnosis
  • Being obese
  • Eating a diet high in cholesterol or low in vitamin D

The best way to keep HCV from progressing is through treatment. Newer drugs called direct-acting antivirals (DAAs) have very high cure rates and few side effects. Talk with your doctor to see if these or other treatment options are right for your specific case.1,5

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