Hepatitis C: Outlook and end-stage liver disease
Hepatitis C occurs when the hepatitis C virus, also known as HCV, infects the cells in the liver. A person may contract HCV by coming into contact with the blood or bodily fluids of someone with the virus.
This article discusses the stages of liver disease and the outlook for people who have hepatitis C in the later stages.
Stages of hepatitis C
The terms “acute” and “chronic” refer to the length of time that a person has had the hepatitis C virus.
Acute hepatitis C
Acute hepatitis C presents in the first 6 months after exposure to the hepatitis C virus. There is a 20 to 50 percent chance that the infection will clear on its own within this time.
Chronic hepatitis C
In people with chronic hepatitis C, the infection lasts for longer than 6 months. Hepatitis C becomes chronic in as many as 75 to 85 percent of cases.
Chronic hepatitis C can remain undetected for a prolonged period.
The chronic liver disease that it causes tends to progress slowly over several decades, and people often either show no symptoms or experience general tiredness and depression.
For this reason, many people will not know that they have the infection until a doctor detects it during a routine blood screening.
A doctor can determine how severe a person’s liver scarring is by carrying out a liver biopsy.
A higher score indicates a more significant disease progression. Healthcare professionals use the METAVIR scoring system to assess the progression of liver fibrosis.
The system assigns a grade to the level of inflammation and the stage of fibrosis.
The METAVIR stages of inflammation are as follows:
The METAVIR stages of fibrosis are as follows:
A doctor may conduct the following tests to assess the best course of treatment for an individual with hepatitis C:
- virus tests to find out the specific strain of HCV
- blood tests to assess liver function
- an abdominal ultrasound to look for liver scarring
- an assessment of the stage of fibrosis
- tests to rule out other infections, such as hepatitis B and HIV
The treatment options depend on the severity of liver disease that the tests reveal.
Hepatitis C with compensating cirrhosis
Oral antiviral medications, which remove the virus from a person’s blood, are the primary treatment for hepatitis C. The aim is to make the virus undetectable in the blood, which shows that the medication is working. Doctors refer to this as a virologic response.
If this response lasts for 12 weeks or more after finishing treatment, the person has achieved a sustained virologic response (SVR). Around 99 percent of people who have an SVR remain virus-free for the rest of their lives.
Although antiviral treatment is generally more successful when liver fibrosis has a METAVIR score of F2 or below, people with stage F3 or even stage F4 fibrosis can reach SVR.
After achieving an SVR, the hepatitis C infection will not cause further liver damage. However, people with advanced fibrosis or cirrhosis may continue to experience complications as a result of the existing liver damage.
Hepatitis C with decompensating cirrhosis
Until recently, doctors considered a liver transplant to be the only effective treatment for decompensating cirrhosis.
However, a recent small-scale study found that a course of direct-acting antiviral (DAA) medication may improve some people’s liver function enough to take them off the waiting list for a liver transplant. People with liver disease that was less severe had a higher likelihood of removal from the list.
However, recent Canadian guidelines warn that certain antiviral drugs may potentially be dangerous for people with severe decompensating cirrhosis. This is because the liver is less able to filter out toxic waste, meaning that the antiviral drugs could accumulate to toxic levels. Doctors must weigh up the benefits against the risks.
When a person is waiting for a liver transplant, a doctor will assess whether or not to pause antiviral treatment.
Summary
Hepatitis C is a viral infection that can cause severe liver damage, including cirrhosis and fibrosis. The treatment of chronic hepatitis C will depend on the stage of liver disease and cirrhosis.
In its earlier stages, doctors can sometimes cure hepatitis C with antiviral medications. In some cases, a person with late-stage hepatitis C may need a liver transplant.
Advances in modern medicine mean that the outlook for hepatitis C is improving.
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