Hepatitis C 101: What are the stages of hepatitis C? An Overview

Hepatitis C (HCV) is a viral infection that can lead to liver inflammation, liver damage, liver cancer, and in some cases, when left undetected and untreated, it can be fatal. Although some individuals will clear the infection on their own, the majority of people who acquire HCV progress to a long-term, chronic infection that can last a lifetime. Whether acute or chronic, many of the folks who have a hepatitis C infection don’t know it, because symptoms are often undetectable or so mild they go unnoticed (asymptomatic) – even when/if damage is occurring to the liver.

How hepatitis C begins

Hepatitis C is contracted through blood transmission. Anyone who comes into contact with another person’s blood is at risk of contracting HCV, including but not limited to: healthcare workers, people who share needles with others, individuals who have undergone kidney dialysis or blood transfusions, and those who have unprotected sex with partners. The hepatitis C virus can also be transmitted from mother to child during childbirth.

Very few people experience any warning signs or symptoms of infection for upwards of 10-20 years after they have contracted the hepatitis C virus. Other symptoms are so mild – ranging from a loss in appetite to fatigue – that most people are entirely unaware they have an infection. A small percentage of those who contract HCV – around 15-20%, according the U.S. Department of Veterans Affairs (VA) – will clear the virus on their own, because their immune system will fight the infection. Those who clear the virus typically do not sustain any long-term damage to their liver or their overall health. Others, however, will not be able to clear the virus without treatment, and their infection will progress to long-term, chronic hepatitis C.

Acute stage

The acute phase of HCV occurs within the first six months of the infection. While most people do not experience any noticeable symptoms, those who do may notice symptoms such as mild jaundice, a loss of appetite, or fatigue. Those symptoms will eventually subside as the body’s immune system fights the infection. For the majority of others, though, the virus will persist beyond six months and will enter the chronic stage.

Chronic stage

For those who do not clear the virus on their own, hepatitis C will progress to a long-term, chronic infection. This progression is gradual and usually occurs over a number of years. During which, inflammation of the liver can begin to occur, and eventually, that inflammation causes healthy liver cells to die, and liver tissue to become scarred and hardened (cirrhosis). According to the VA, 20% of chronic hepatitis C cases progress to cirrhosis of the liver. Progression to cirrhosis can take upwards of 10 to 20 years – sometimes longer – and many of the people who experience cirrhosis do not have noticeable symptoms for years at a time.

End stage (compensated & decompensated cirrhosis)

When a healthy liver is infected with the hepatitis C virus, it becomes inflamed, inflammation causes liver cells to be replaced with hardened scar tissue, and that scar tissue is called cirrhosis. When the liver suffers cirrhosis, it has trouble filtering toxins, and those toxins build up in the blood stream. During the early stages of cirrhosis, some people will experience symptoms such as swelling in the abdomen, brain fog, or fatigue, while others will not experience any noticeable symptoms at all. This early period of cirrhosis is called compensated cirrhosis.

HCV progresses to end-stage hepatitis C, or decompensated cirrhosis, when the liver has been severely damaged by inflammation and scarring and severe complications arise. When this happens, the liver is unable to function properly and serious, life-threatening health issues persist. These complications can include liver failure, liver cancer, and eventually, fatality. During end stage hepatitis C, patients might experience jaundice, extreme fatigue, nausea or loss of appetite, loss of hair, internal bleeding, and/or trouble thinking as a result of damages to the digestive and nervous systems.

At this stage, a liver transplant is one of the most common recommendations, because the damage sustained by the liver is irreversible. Even after a liver transplant, though, patients must be closely monitored, because hepatitis C can return.

Factors Affecting HCV Progression

Knowing when someone contracted the hepatitis C infection is the first step in determining possible progression of the disease. However, since many people do not know how or when they contracted the virus, it can be difficult to predict how fast someone will progress through the stages of HCV.

Individual experiences with the progression of HCV vary greatly – some clear the virus on their own and never progress past the acute stage of infection, other progress to a long-term or chronic infection over a number of years.

Yet, even those with chronic HCV have a wide range of symptoms, and symptoms themselves do not always indicate the level of severity of infection or damage to a person’s liver. Some people who are living with chronic HCV notice no symptoms but have extensive scarring of the liver, and others will experience a number of HCV-related symptoms, but their blood tests, enzyme levels, or liver biopsy will indicate their liver is only mildly impacted.

The array of experiences across those who are living with hepatitis C make it difficult to discern which symptoms will develop for whom and when. Lately, a significant amount of research has become available to help aid practitioners in determining how an individual might progress through the stages of hepatitis C, but there’s still work to be done to help provide a more accurate prognosis for each patient.^1-6