After exposure to the Hepatitis C virus, the window period before antibodies can be detected using a standard test usually lasts from 2 to 26 weeks. The initial phase of hepatitis C is called acute infection. Acute HCV infection may resolve with spontaneous viral clearance, typically within 2–12 weeks. However, up to 75% of people initially infected with HCV do not clear the virus from their bodies within six months and become chronically infected.
Most people with chronic hepatitis C do not have symptoms and lead relatively normal lives. But in 10%–25% of people, the disease progresses over the course of 10–40 years. There are no tests or other methods to identify who will progress to serious disease progression, so it’s important that all people with chronic hepatitis C are monitored on a regular basis and discuss treatment options with their medical provider.
A liver biopsy is useful in measuring the extent of any liver damage. The findings of a liver biopsy can be used in combination with the estimated date of initial infection to make an educated guess as to the rate of HCV disease progression.
The Fibroscan is another test for measuring liver damage. It is a machine that works by sending radio waves through the liver to gauge the level of damage (if any) of the liver. This test may be used with various blood tests to gauge the health of the liver. Fibroscan is now replacing the liver biopsy because it is a painless procedure, unlike the liver biopsy. There are also various combinations of blood tests that are used to monitor the liver.
Chronic HCV infection can lead to the development of fibrous tissue in the liver (fibrosis and at later stages, cirrhosis), fat accumulation in the liver (steatosis), liver cancer, and end-stage liver failure. In severe cases, a person may require a liver transplant.
Fibrosis and cirrhosis occur when liver cells are damaged or die off and healthy liver tissue is replaced with fibrotic tissue. Extensive scar tissue can impair the flow of blood through the liver and cause blood to back up, leading to further loss of liver function and serious complications.
Compensated cirrhosis means that the liver is heavily scarred but still able to perform most of its vital functions; people with compensated cirrhosis may exhibit few symptoms, but need more careful monitoring.
Decompensated cirrhosis means that the liver is so extensively scarred that it is unable to function properly, leading to serious complications that can greatly affect overall health and bodily functions. People with decompensated cirrhosis often develop complications such as varices (stretched and weakened blood vessels) in the esophagus and stomach, internal bleeding, ascites (fluid accumulation in the abdominal cavity), and other potentially life-threatening conditions. Encephalopathy (reversible mental confusion) is when toxins build up in the brain due to impaired filtering is another complication of decompensated cirrhosis.
Liver cancer can develop at later stages of HCV infection after a person has developed advanced fibrosis (stage 3) or cirrhosis. The type of liver cancer associated with HCV is called primary hepatocellular carcinoma (HCC).
Hepatitis C Facts
- Acute hepatitis C is the initial infection—the Centers for Disease Control estimates that more than 41,000 acute infections in the United States in 2016
- Chronic hepatitis C infection is defined as the hepatitis C virus is in the body for six months or longer
- The Centers for Disease Control estimates that about 3.5 million Americans are living with hepatitis C
- More than 19,000 Americans die from hepatitis C every year
Next: Symptoms of Hepatitis C