Hepatitis C and Cirrhosis: The Connection and Prognosis

There are around 3.5 million people (1) in the US alone who suffer from chronic hepatitis C, and the surprising part is that most of these infected people are not even aware of it. Over the years, if hepatitis C is left untreated, it can cause major damage to your liver.

Consider this, out of 75 to 85 people who have chronic hepatitis C, nearly 5 to 20 of them end up developing cirrhosis of the liver. (1) In fact, infection by the hepatitis C virus (HCV) is one of the leading causes of cirrhosis and liver cancer.

We have established that hepatitis C can lead to cirrhosis. However, cirrhosis cannot be a cause of hepatitis C. This is because, in order to get hepatitis C, the person needs to be exposed to the hepatitis C virus.

HCV is a virus that people contract from blood to blood transmission. Transmission of HCV can also occur through:

• Sexual intercourse
• Being born to a parent who has HCV
• Sharing needles
• Injury by needle stick in healthcare workers
• You may have hepatitis C for many years without being aware of it.

Everyone is aware of the importance of the liver. The liver is responsible for the detoxification of your blood and also manufactures critical nutrients for the body. Many factors can cause damage to the liver, including:

• Hepatitis
• Chronic alcohol abuse
• Parasites

Over a period of time, inflammation of the liver can lead to scarring and permanent damage. This is known as cirrhosis. Once cirrhosis sets in, the liver is then unable to heal itself. Cirrhosis can further lead to:

• Liver cancer ⁽²⁾
• End-state liver disease
• Liver failure

There are two stages of cirrhosis – compensated cirrhosis and decompensated cirrhosis.

Compensated cirrhosis occurs when the body still continues to function in spite of decreased liver function and scarring. On the other hand, decompensated cirrhosis means that all liver functions break down, and you may experience some severe symptoms such as kidney failure, hepatic encephalopathy, and variceal hemorrhage.

The troubling fact is that hepatitis C can be an invisible infection. There are usually very few symptoms after the initial infection by HCV. Many patients who have hepatitis C do not even come to realize that they have the disease.

The hepatitis C virus attacks the liver, and many people who are infected go on to developing a chronic infection. Chronic HCV infection caused inflammation and damage to the liver over a period of time. In many cases, the condition might not get diagnosed even up to 20 to 30 years.

It is highly likely that you will not experience any symptoms of liver cirrhosis until a considerable amount of damage has already happened to your liver. When you do start experiencing the symptoms, they may include:

• Fatigue
• Weight loss
• Loss of appetite
• Nausea
• Itchy skin
• Bleeding or bruising easily
• Swelling in legs
• Jaundice or yellow discoloration in eyes and skin
• Fluid present in the abdomen (a condition known as ascites)
• Abnormal blood test reports, including albumin, bilirubin, and coagulation factors
• Enlarged veins in the upper stomach and esophagus that may lead to bleeding, a condition known as variceal hemorrhage
• Infection of the abdominal lining and ascites
• Impaired mental functioning due to accumulation of toxins, a condition known as hepatic encephalopathy
• During the diagnosis process, a liver biopsy will show scarring, confirming the presence of cirrhosis in people who have hepatitis C already.
• Laboratory tests, as well as a physical exam, will also help your doctor diagnose advanced liver disease without requiring a biopsy.

A quarter of people who have hepatitis C go on to develop liver cirrhosis. However, certain factors are known to increase your risk of developing cirrhosis. These include:

• Regular alcohol use
• Infection with another virus such as hepatitis B or HIV
• High levels of iron present in the bloodstream
• History of taking immunosuppressive drugs

This is why doctors often advise those with chronic HCV infection to avoid alcohol. People over the age of 45 also have a higher risk of developing cirrhosis.

Doctors often recommend aggressive treatment of hepatitis C in younger people to help prevent the disease from progressing to cirrhosis.

If you have cirrhosis, you must remain healthy and follow a healthy lifestyle. You need to keep up to date with all your vaccinations including:

• Hepatitis A and B
• Influenza
• Pneumonia

Cirrhosis is known to bring about a change in the way in which blood flows through the body, and scarring of the liver may further block the blood flow through the liver.

Blood may also shunt through the larger blood vessels in the esophagus and stomach, causing these blood vessels to enlarge and eventually rupture, leading to bleeding in the stomach. This is why you need to watch out for any abnormal bleeding.

Another possible complication of cirrhosis is liver cancer. Your doctor will use ultrasound and other blood tests regularly to keep checking for cancer.

Some of the other complications of cirrhosis include:

• Diabetes ⁽³⁾
• Gingivitis or gum disease
• Changes in how medications get processed inside the body

When you first contract HCV, you are likely only to experience mild illness. Sometimes the body can clear the virus completely. The remainder goes on to experience a chronic HCV infection.

Bear in mind, though, that not every person with hepatitis C will get cirrhosis. Doctors look at many factors and symptoms while determining a person’s outlook if they have cirrhosis and hepatitis C.

For example, according to a 2014 study done by the Kanazawa Medical University in Japan and published in the World Journal of Gastroenterology (4), the outlook is often worse for people who have:

• Low platelet counts
• Low serum albumin levels
• Increased serum alpha-fetoprotein levels

Cirrhosis that is caused by HCV generally takes decades to develop fully. If somebody already knows that they have hepatitis C, it is essential to seek proper medical care to prevent hepatitis C from causing cirrhosis.

Due to this, doctors typically recommend that a person who has the following risk factors undergo testing for hepatitis C:

• Receiving long-term hemodialysis
• Born to mothers who have hepatitis C
• Are current or former intravenous drug users
• Have a history of exposure to HCV, for example, hospital/healthcare workers
• Have tattoos that have been done by unlicensed artist
• Have had a blood transfusion before July 1992, from which point screening became widespread
• Is or was in prison or jail
• Has HIV infection
• Was born from 1945 to 1965 ⁽⁵⁾

If you are lucky and your doctor detects hepatitis C before it leads to major liver damage, they will prescribe medications that will help cure a majority of patients. However, if you already have liver cirrhosis, then also treating and curing hepatitis C that will not reverse the liver damage that has already been caused.

When a hepatitis C patient has cirrhosis, the goal of the treatment revolves around minimizing and preventing any further damage to the liver. Let us take a look at the different treatment options for achieving the same.

If you have both hepatitis C and cirrhosis, then the focus of your treatment will revolve around preventing any further liver damage. The most important thing after being diagnosed with both these conditions is to avoid drinking alcohol as this will aggravate damage to the liver.

The liver is capable of filtering out many medications, and if you are taking any of the following medicines, then you must inform your doctor as they could potentially cause further harm to the liver:

• Supplements
• Herbal medications
• Prescription medicines
• Other drugs

Your doctor may also prescribe certain medications that will help in decreasing the chances of experiencing internal bleeding and accumulation of excess fluid in the stomach. Routine testing for liver cancer will also be recommended.

Cirrhosis of the liver may ultimately lead to liver failure, a condition where the liver stops working altogether. When this happens, a person may require to undergo a liver transplant to survive. However, not everybody is the right candidate for a liver transplant, and the list of people awaiting transplants is also very long.

A liver transplant is only effective for curing advanced cirrhosis. Also, a majority of people who receive a liver transplant due to hepatitis C survive for another five years following the transplant. It has been observed that hepatitis C tends to return usually. Hepatitis C is one of the most common causes of liver transplants in the US.

Hepatitis C can cause cirrhosis of the liver or severe scarring of the liver, which may lead to liver damage. Liver cirrhosis is also known to increase the risk of liver cancer and liver failure.

Your doctor will prescribe medications for curing hepatitis C and also try to prevent the development of cirrhosis.

However, once cirrhosis begins, there is no cure for the condition. Treatment options will only revolve around offering support and aiming to prevent further damage in hepatitis C-associated cirrhosis.

People with hepatitis C-related cirrhosis can continue to live a healthy life for many decades, especially if it gets diagnosed early on and is managed well. Using direct-acting antivirals will help slow down or prevent the progression of hepatitis C to cirrhosis. If, however, liver cirrhosis is left untreated, it will eventually lead to liver failure.

References

1. Cdc.gov. (2019). Hepatitis C Questions and Answers for the Public | CDC. [online] Available at: https://www.cdc.gov/hepatitis/hcv/cfaq.htm [Accessed 29 Oct. 2019].
2. Nishiguchi, S., Shiomi, S., Nakatani, S., Takeda, T., Fukuda, K., Tamori, A., Habu, D. and Tanaka, T., 2001. Prevention of hepatocellular carcinoma in patients with chronic active hepatitis C and cirrhosis. The Lancet, 357(9251), pp.196-197.
3. Bigam, D.L., Pennington, J.J., Carpentier, A., Wanless, I.R., Hemming, A.W., Croxford, R., Greig, P.D., Lilly, L.B., Heathcote, J.E., Levy, G.A. and Cattral, M.S., 2000.
4. Hepatitis C–related cirrhosis: A predictor of diabetes after liver transplantation. Hepatology, 32(1), pp.87-90.
5. Toshikuni, N., Arisawa, T. and Tsutsumi, M., 2014. Hepatitis C-related liver cirrhosis-strategies for the prevention of hepatic decompensation, hepatocarcinogenesis, and mortality. World Journal of Gastroenterology: WJG, 20(11), p.2876.
6. Cdc.gov. (2019). [online] Available at: https://www.cdc.gov/knowmorehepatitis/media/pdfs/factsheet-boomers.pdf [Accessed 29 Oct. 2019].

Also Read:

• What is Hepatitis C, How Does it Spread and Ways to Prevent Liver Damage in Hepatitis C
• How Hepatitis C Affects Different Systems of Your Body?
• Is It Possible To Cure Hepatitis C?
• Treatment of Hepatitis C: Traditional Treatments & Advances in Hepatitis C Treatments