Hepatitis C is the most common cause of cirrhosis, which occurs when scar tissue forms in the liver due to inflammation or injury. The virus is spread through contact with infected blood or blood products, with injecting drug use being the most common route. Treatment depends on the stage, with early-stage cirrhosis having a good prognosis and liver transplantation being the only option for advanced cirrhosis. Treatment for the underlying hepatitis C infection is crucial to control liver inflammation and damage.
Cirrhosis occurs when large amounts of scar tissue form in the liver. Scar tissue, or fibrosis, could result from inflammation or injury. A hepatitis C infection causes the liver to become inflamed and, over time, can lead to cirrhosis. Chronic hepatitis C infection is believed to be the most frequent cause of cirrhosis worldwide, which means that there is a very close relationship between cirrhosis and hepatitis C.
Hepatitis C is caused by a viral infection. The infection is spread by contact with infected blood or blood products. Injecting drug use and sharing improperly sterilized needles are the most common routes of viral transmission. Blood screening procedures have eliminated the risk of contracting the virus from blood transfusions, although this was a risk before the early 1990s. Many people with cirrhosis and hepatitis C infection have no known exposure or risk factors.
Most people infected with the hepatitis C virus will not develop cirrhosis. The infection is short-lived in about 25% of infected people. Acute infection does not cause liver damage. Although hepatitis C is the most common cause of cirrhosis, only about 20% of people with chronic hepatitis C infection develop cirrhosis.
Hepatitis C-related cirrhosis takes decades to develop. Prolonged inflammation causes scar tissue, which gradually replaces healthy living tissue. Hardened scar tissue blocks blood flow through the liver and prevents the liver from working properly. While a healthy liver can regenerate cells to repair damage, a liver in the late stages of cirrhosis can no longer repair itself.
Certain factors increase a person’s risk for developing cirrhosis and hepatitis C. The most important risk factor is past and current alcohol consumption. Other factors that accelerate progression to cirrhosis include being older than 45 and coinfection with human immunodeficiency virus (HIV) or hepatitis B virus. Some people with none of the risk factors have disease in rapid progression.
Treatment of cirrhosis and hepatitis C depends on the stage. People who have early-stage cirrhosis have a good prognosis and could live for several decades without complications. Treatment in the early stages is to keep the person healthy for as long as possible and to treat complications as they arise. Possible complications include ascites or fluid accumulation in the abdomen; encephalopathy, or a degenerative brain disease; or variceal bleeding. Liver transplantation is the only treatment for advanced cirrhosis.
Treatment of the underlying hepatitis C infection is of paramount importance to control liver inflammation and damage. PEGylated interferon combined with ribavirin is standard therapy. Ribavirin is an antiviral drug that, by itself, has little effect on the hepatitis virus. In combination with interferon, however, ribavirin becomes two to three times more effective. Pegylated interferon is injected once a week for 24 or 48 weeks.
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