How Serious is Hepatitis C?

Hepatitis C is a liver infection with outcomes that are somewhat unpredictable. For some, the infection will remain benign and a person will live a full life without knowing that they have it. For others, it is a short-term illness, but for more than half of those infected it evolves into a very serious illness, one that can have disastrous consequences if left untreated.¹

What are the symptoms of hepatitis C?

Every hep C chronic infection begins with an acute phase; There may be no obvious symptoms and therefore it is often left untreated. For others, hep C indicators and symptoms do appear and as described by the Mayo Clinic, they include “jaundice, along with fatigue, nausea, fever and muscle aches. Acute symptoms appear one to three months after exposure to the virus and last two weeks to three months".²

Even after the condition manifests into a chronic state, it may remain “silent”. “Silent” only means the infection has no obvious side effects, yet it can still cause liver damage. As the damage to the liver becomes more severe, health consequences can include: bleeding or bruising easily, fatigue, poor appetite, yellow discoloration of the skin and eyes (jaundice), dark-colored urine, itchy skin, fluid buildup in the abdomen (ascites), swelling in the legs, weight loss, and spider-like blood vessels on your skin (spider angiomas), as well as confusion, drowsiness, and slurred speech (hepatic encephalopathy).

Hepatitis C can cause liver damage

When left untreated in its chronic state, the impacts of hep C often become more consequential as the liver is more significantly impacted. With a long-term, untreated condition, many people develop mild to severe chronic liver disease, leading to scarring of the liver known as cirrhosis. Approximately 1 in 3 patients will develop cirrhosis within twenty to thirty years after infection that will impact liver function or in some cases, cause liver cancer. Both can become terminal conditions if treatments or a liver transplant are not successful.³

According to the NHS, the following can increase the risk of getting cirrhosis:³

• Drinking alcohol
• Having type 2 diabetes
• Getting hepatitis C at an older age
• Having HIV
• Having another type of hepatitis, such as hepatitis B

Common tests and procedures

To assess liver function and the degree of damage, doctors usually use one of the following assessment procedures:²

• Magnetic resonance elastography (MRE): This alternative to a liver biopsy combines magnetic resonance imaging with patterns formed by sound waves to show gradients of stiffness throughout the liver. If the liver tissue is stiff, this indicates the presence of liver scarring (fibrosis) as a result of chronic hepatitis C.
• Transient elastography: A type of ultrasound that transmits vibrations into your liver to measure stiffness.
• Liver biopsy: Typically done using ultrasound guidance, this test involves inserting a thin needle through the abdominal wall to remove a small sample of liver tissue for laboratory testing.
• Blood tests: Blood tests can also help measure liver fibrosis.

Long-term effects of hep C

Even after successful treatment, those with hep C may have liver abnormalities for several years. Some studies also indicate that alcohol can worsen chronic hep C-related liver damage and increase health risks. Those findings include:

• Liver scarring (fibrosis): Chronic hepatitis C infection often causes liver fibrosis, which can continue even after treatment. Drinking alcohol can worsen scarring by speeding up liver damage
• Infection relapse: While it's rare, hepatitis C infection can reappear after treatment. Relapses usually typically occur in the first few months after confirming that the virus is no longer detectable via blood test. However, a relapse can also present much later.
• Liver cancer risk: Hepatitis C-related liver damage increases the risk of developing liver cancer. However, curing your hepatitis C significantly lowers your risk of liver cancer.

Treatment options

Given the increased risks for liver failure, cancer, and the debilitating side effects of hepatitis C, it is difficult to refute the enormous benefits DDA treatments can offer. Direct-acting antivirals (DAA’s) developed over the last decade are significantly more effective than the previous options in eliminating the disease and reducing side effects, as well as the ease of ingestion. As noted in a 2019 paper, “The treatment of CHC has undergone significant advancement over the past decade. In particular, the cure rate with new DDAs has climbed to over 90% across genotypes, with some of the newest DDAs achieving a cure rate of 100% in certain genotypes".^4-7 Since it is hard to predict if and when hep C will evolve from the acute stage to the chronic stage, treatment is the best option to eliminate the disease and lower the risk of negative long-term health impacts. DDA treatments are expensive and the costs, unfortunately, remain a barrier for many of those infected with Hep C.