Being infected with HCV does not necessarily mean that liver disease
will occur. What's more, it can take several years – decades, in
many cases – for HCV to cause life-threatening liver disease.
Soon after HCV enters the body, it infects cells in the liver called
hepatocytes. Only a small number of people (approximately 25%) actually
experience symptoms of infection, such as fatigue,
decreased appetite, nausea, or jaundice
(yellowing of the skin and eyes). However, almost all people infected
with HCV experience an increase in their liver enzymes – such as
serum alanine aminotransferase (ALT) – which can be detected by a
simple blood test. An increase in ALT means that some liver cells are
becoming damaged by the HCV infection.
Approximately 15% of people who are infected with HCV are able to clear
the virus from their bodies, usually within six months after becoming
infected. However, the majority of people (85%) who are infected with
HCV have "chronic" hepatitis C – an infection that will
stay with them for life. In other words, if 100 people are infected with
HCV tomorrow, 15 of them will clear the virus from their bodies within
six months, whereas 85 of them will remain infected with the virus.
Of the 85 people with chronic hepatitis C, approximately 20 of them will
remain healthy – their liver enzymes will stay normal, even though
HCV can be detected in their livers and in their blood, and they will
not go on to develop liver disease or experience symptoms of the infection.
The remaining 60 to 65 people with chronic hepatitis C will go on to experience
some signs and symptoms of liver disease, such as fatigue, nausea, muscle
aches, and abdominal pain – usually after 13 to 15 years of being
infected with HCV. Approximately 20 to 25 of these people, usually after
20 years of HCV infection, will develop cirrhosis – a scarring of the
liver that results from widespread fibrosis (an extreme overgrowth of
the liver's connective tissue). Here are some pictures of a healthy liver,
then fibrosis, then cirrhosis:
Although cirrhosis is not life threatening, it can affect the way the
liver works and increases the risk of liver cancer. Of the 20 to 25 people
with HCV who develop cirrhosis, between five and 10 of them will develop
liver cancer and possibly liver failure after another five years.
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