Living with hepatitus c

What is the prognosis for hepatitis C?

According to the CDC, around 10–20% of people with chronic untreated HCV will eventually develop cirrhosis. Cirrhosis is a condition in which scarring occurs on the liver.

Symptoms

Cirrhosis can cause symptoms such as:

  • bruising and bleeding easily
  • swelling in the lower legs, ankles, or feet
  • confusion
  • difficulty thinking
  • memory loss
  • personality changes
  • sleep disorders
  • ascites, or bloating from a buildup of fluid in the abdomen
  • severe itchy skin
  • dark urine
  • jaundice

Treatment

Treatment for living scarring or damage tends to involve treating both the virus and the liver. For people with end stage cirrhosis due to chronic HCV, the best treatment option is a liver transplant.

A liver transplant can correct both liver damage and liver cancer. However, only a small number of liver transplants are available.

Outlook

Cirrhosis may develop faster in certain groups of people. The following factors can increase the speed at which cirrhosis advances:

  • sex (males have a higher risk than females)
  • the presence of nonalcoholic fatty liver disease
  • age (people over the age of 50 have a higher risk)
  • alcohol consumption
  • hepatitis B or HIV coinfection
  • immunosuppressive therapy

According to the CDC, people who develop cirrhosis from HCV have a 1–5% chance of developing liver cancer. They also have a 3–6% annual chance of developing hepatic decompensation and liver failure.

Hepatic decompensation occurs when a person with cirrhosis begins to show symptoms of the condition because the liver is having trouble functioning. People who develop hepatic decompensation have a 15–20% risk of death the following year.

The CDC report that in 2017, 17,253 deaths in the U.S. had HCV listed as a contributing factor. More than 70% of these deaths also had moderate-to-severe liver disease listed as a cause.

These statistics enforce the notion that HCV alone will rarely lead to death. It is the complications that develop over many decades of living with the virus that tend to lead to death. The average age of these HCV-related deaths was 59.

It is also important to note that the CDC explain that the number of deaths may be a little low because of incorrectly reported conditions on death certificates.

Learn more about the possible complications of HCV here.

Living With the Hepatitis C Virus

Though hepatitis C begins as an acute infection lasting just a few weeks, for 70 to 85 percent of people infected, the hepatitis C prognosis is for a chronic condition, according to the Centers for Disease Control and Prevention, CDC. The virus will stay in the body and continue to attack the liver.

“Chronic hepatitis C virus is known as the ‘silent killer’ because it is often asymptomatic until the liver starts to fail,” says Camilla Graham, MD, an assistant professor of medicine at Harvard Medical School in Cambridge, Mass. “Chronic infection can progress to serious liver disease, including scarring of the liver (fibrosis) and advanced scarring (cirrhosis).”

Over time, between 5 and 20 percent of people with the hepatitis C virus will develop cirrhosis, and between 1 and 5 percent will ultimately die from conditions related to the hepatitis C virus.

The hepatitis C virus can lead to additional complications for the liver. “In some cases, those with cirrhosis will go on to develop liver cancer or other complications of cirrhosis,” including life-threatening bleeding of the esophagus or stomach, or build-up of fluid in the abdomen, says Dr. Graham. “In the United States, hepatitis C virus is the leading cause of liver cancer.” It’s also the leading reason for liver transplantation.

For those with hepatitis C, a gradual degradation of the liver that ultimately results in cirrhosis usually takes between 20 and 30 years to develop. “Once cirrhosis develops, the annual incidence of liver cancer is about 3 to 5 percent per year,” says John M. Vierling, MD, the director of Advanced Liver Therapies for St. Luke’s Episcopal Hospital in Houston.

How Is Hepatitis C Treated?

Thanks to drug advances, many people with the hepatitis C virus can be cured with hepatitis C treatment.

The most common hepatitis C treatment used to be a two-part therapy that involved weekly injections of the drug pegylated interferon and a regimen of an antiviral drug called ribavirin, taken in pill form.

The course of this hepatitis C treatment was long, lasting 24 to 48 weeks, depending on response to the drugs, and effective for about 50 percent of patients. Side effects including skin rashes and other skin problems, weight loss, fatigue, cough, flu-like symptoms, general pain, and anemia were common.

Newer hepatitis C drugs with cure rates of 90 percent and higher include Olysio (simeprevir), Sovaldi (sofosbuvir), Harvoni, and Viekira Pak. These medications have fewer side effects and shorter treatment times.

RELATED: People Like Me With Hepatitis C

Living Well With Hepatitis C

Even if hepatitis C treatment doesn’t rid your body of the disease, you can still live a healthy and productive life. Making positive lifestyle changes are particularly important for those living with hepatitis C to protect their liver as well as manage the emotional strain of the disease. Graham suggests these seven steps:

  1. Abstain from alcohol and drug use.
  2. Find a support group, so that you can share your thoughts, feelings, concerns, and emotions about the disease.
  3. Attend regular check-ups with your doctor to get the best care possible.
  4. Eat a healthful, balanced diet with plenty of fruits and vegetables and avoid too much salt, sugar, and fat.
  5. Do gentle exercises like walking and swimming as frequently as you are able.
  6. Avoid harmful fumes and toxins like paint thinner or cigarette smoke that can further damage the liver.
  7. Rest whenever you feel tired to avoid overtaxing your body and immune system.

Planning for the Future

You may want to make long-range financial plans for better peace of mind. This may include working closely with a trusted financial advisor to obtain the appropriate life insurance policy or investments to protect your family if your condition worsens. If you are under long-term care for your hepatitis C treatment, you may be eligible for financial assistance through the government or specific hepatitis drug manufacturers.

Life expectancy among patients with chronic hepatitis C virus infection, cirrhosis

Almost three million people in the United States are chronically infected with the hepatitis C virus (HCV). The life expectancy of patients with chronic HCV infection is reduced compared with the general population, largely attributable to the development of cirrhosis, liver failure and cancer. Studies have shown that the risk of all-cause death is lower among patients with chronic HCV infection and advanced hepatic (liver) fibrosis (development of excess fibrous connective tissue) if sustained virological response (SVR) is attained, but comparisons have been limited to those without SVR, according to background information in the article.

Adriaan J. van der Meer, M.D., Ph.D., of the Erasmus MC University Medical Center Rotterdam, the Netherlands, and colleagues compared overall survival of patients with chronic HCV infection and advanced fibrosis or cirrhosis before therapy (with and without SVR) with that of the general population. The researchers used data on patients from Europe and Canada with chronic HCV and advanced hepatic fibrosis from a previous study. Follow-up started 24 weeks after cessation of antiviral treatment, at which time achievement of SVR (defined as HCV RNA negativity in a blood sample) was determined. For each virological response group, the observed overall survival was compared with the expected survival from matched age-, sex- and calendar time-specific death rates of the general population in the Netherlands.

In total, 530 patients were followed for a median of 8.4 years; follow-up was complete in 454 patients (86 percent), 192 of whom attained SVR. Thirteen patients with SVR died, resulting in a cumulative 10-year overall survival of 91.1 percent, which did not differ significantly from the age- and sex-matched general population. In contrast, 100 patients without SVR died. The cumulative 10-year survival was 74.0 percent, which was significantly lower compared with the matched general population.

“The excellent survival among patients with advanced liver disease and SVR might be explained by the associations between SVR and regression of hepatic inflammation and fibrosis, reduced hepatic venous pressure gradient, reduced occurrence of hepatocellular carcinoma and liver failure, as well as reduced occurrence of diabetes mellitus, end-stage renal disease, and cardiovascular events. Even though patients with cirrhosis and SVR remain at risk for hepatocellular carcinoma, the annual hepatocellular carcinoma incidence is low and survival is substantially better compared with those without SVR,” the authors write.

What’s the Outlook and Life Expectancy for Hepatitis C?

Chronic HCV is often treatable. It usually involves taking a combination of medications until the virus clears from your body. These drugs work to keep the virus from multiplying and eventually kill off the virus.

Drug regimens for hepatitis C are always changing and getting better. Talk to your doctor about the latest treatments to see if they might work for you.

After treatment, your doctor will make sure the virus is gone. Being clear of the virus, also called sustained virologic response (SVR), means that it will likely not come back. But you can still get reinfected.

In the United States, older drug regimens included interferon injection and Ribavirin, an oral medication. Now, newer oral medications called direct-acting antivirals (DAAs) may be more effective and better tolerated. The percentage of patients clearing the virus to undetectable levels can range from 60 to 95 percent, depending on the:

  • DAA used
  • HCV genotype
  • viral count
  • severity of liver damage prior to treatment

DAAs may also shorten treatment time to between 8 and 12 weeks, depending on the medication used.

The Centers for Disease Control and Prevention (CDC) reports that HCV causes more deaths than any other infectious disease. This is because HCV screening isn’t as routine and people who have the virus aren’t aware of the infection.

It’s important to include routine HCV screening for certain populations to identify the condition before severe damage occurs. A late diagnosis can affect the treatment’s effectiveness.

Genotype

Treatment success for chronic hepatitis C also depends on the genotype of the virus. Genotypes are variations of the virus that have evolved over the years. Some genotypes may be more difficult to treat than others.

Currently, in the United States the most common genotypes are types 1A and 1B, which account for about 70 percent of all cases of hepatitis C.

Cases of hepatitis C in the United States

The CDC reports that deaths associated with hepatitis C reached an all-time high in 2014. This may be because many people born between 1945 and 1965 unknowingly have HCV.

Studies show that baby boomers are five times more likely than other groups to have been exposed to hepatitis C. This is most likely due to receiving blood, blood products, or transplants prior to universal screening procedures. And since people with HCV might not show symptoms, they may unknowingly transmit the virus to others.

Today, the most common risk factor for hepatitis C in the United States is injection drug use.

Since an HCV infection can show no symptoms, the number of new cases is likely higher than reported, according to the CDC.

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