Most people don’t realize they are sick when they have hepatitis C. About 80% of people with an acute infection never have symptoms. The majority of people with acute hepatitis C will develop a chronic infection and still not know it. It can be years or even decades before people discover they have chronic hepatitis C. It’s common to have liver problems when the infection is discovered. Fortunately, hepatitis C prognosis is better today than it has ever been.
Acute Hepatitis C Prognosis
Even when people do develop hepatitis C symptoms, they are usually mild. People often assume they have the flu, with fever, fatigue, body aches, and lack of appetite.
Acute hepatitis C can last for several months. Without treatment, up to 85% of people will have progression to chronic hepatitis C. If your doctor diagnoses acute hepatitis C, you may or may not need treatment. Current guidelines recommend testing again for the virus in six months. If your body has cleared the virus, no treatment is necessary. When virus is still present, treatment at this stage can reduce the risk of developing a chronic infection. Treatment regimens are the same as for chronic hepatitis C.
Chronic Hepatitis C Prognosis
Chronic hepatitis C is a long-term illness that can lead to liver damage, including fibrosis and eventually cirrhosis. In the past, the prognosis for chronic hepatitis C was poor. Treatment involved weekly injections for up to a year. Older hepatitis C drugs were very difficult to tolerate and only cured about half the people taking them. In fact, many people had to stop treatment due to intolerable side effects.
Today, chronic hepatitis C is one of the few chronic diseases doctors can cure. Astounding advances in medication therapy means doctors can now cure more than 95% of people with the virus. What’s more, they can do it with oral medicines over the course of 8 to 12 weeks, for all genotypes of the virus.
Treatment regimens with two antiviral medicines are standard therapy. With some regimens, the cure rate approaches 100%. Cure means you have a sustained viral response (SVR)—lab tests can’t detect the virus in your blood six months after stopping medicines.
Left untreated, chronic hepatitis C can progress to cirrhosis—or permanent scarring of the liver. Eventually, this can lead to end-stage liver failure when the liver stops working. Up to 20% of people with chronic hepatitis C will develop cirrhosis within 2 to 3 decades. Of those, up to 6% will go on to develop end-stage liver failure. Up to 5% will develop liver cancer.
This risk of progression to cirrhosis is higher if you have the following risk factors:
- Age 50 or older
- Have nonalcoholic fatty liver disease (NAFLD) or coinfection with hepatitis B or HIV
- Male biological sex
- Take immunosuppressant drugs
- Use alcohol
It is still possible to treat cirrhosis due to hepatitis C. Treatment can’t reverse the damage because it is permanent. But it can improve the overall health of your liver. The only treatment for end-stage liver failure is liver transplantation. In the United States, hepatitis C is the most common reason for liver transplantation.
Hepatitis C Survival
In 2018, the CDC (Centers for Disease Control and Prevention) published the National Viral Hepatitis Progress Report. It looked at data from 2010 to 2016. During those years, the rate of acute hepatitis infections steadily increased. Experts believe a portion of this increase is due to better screening to identify people at risk.
The same report also looked at the rate of deaths from hepatitis C. Despite rising rates of infection, the death rate peaked in 2013 and has been falling since then. Between 2013 and 2016, it fell by 11.5%. This reversal in the death rate trend coincides with the availability of curative hepatitis C treatments.
The CDC has set a goal of further decreasing the hepatitis C death rate by another 6.3% in 2020. This would bring the death rate to 4.17 deaths per 100,000 U.S. population. They plan to reach this goal with the following strategies:
- Implementing educational campaigns to increase awareness
- Increasing the ability of healthcare providers to identify people at risk
- Increasing hepatitis C testing
- Increasing access to treatment and hepatitis C drug affordability
Hepatitis C treatment—and possibly prevention with a vaccine—is a rapidly evolving area of medical science. Your hepatitis C specialist is the most reliable source of information in this changing landscape. Your doctor is also best able to help you understand how information about hepatitis C treatment and prognosis applies to you.
