What is the prognosis of hepatitis C (hep C) infection?

Updated: Oct 07, 2019
  • Author: Vinod K Dhawan, MD, FACP, FRCPC, FIDSA; Chief Editor: BS Anand, MD  more...
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Infection with hepatitis C virus (HCV) is self-limited in 15% to 50% of patients. [1, 16, 34, 35] In a review of HCV infection, it was reported that chronic infection developed in 70%-80% of patients. [12] Cirrhosis develops within 20 years of disease onset in 20% of persons with chronic infection. [36] The onset of chronic hepatitis C infection early in life often leads to less serious consequences. [32, 33] Hepatitis B virus (HBV) coinfection, iron overload, and alpha 1-antitrypsin deficiency may promote the progression of chronic HCV infection to HCV-related cirrhosis. [34, 35]

Two studies of compensated cirrhosis in the United States and Europe showed that decompensation occurred in 20% of patients and that hepatocellular carcinoma (HCC) occurred in approximately 10% of patients. [37, 38] The survival rate at 5 and 10 years was 89% and 79%, respectively. HCC develops in 1-4% of patients with cirrhosis each year, after an average of 30 years.

The risk of cirrhosis and HCC doubles in patients who acquired HCV infection via transfusion. [39] Progression to HCC is more common in the presence of cirrhosis, alcoholism, and HBV coinfection.

Bellentani et al [40] and Hourigan et al [41] reported that the rate and likelihood of disease progression is influenced by alcohol use, immunosuppression, sex, iron status, concomitant hepatitis, and age of acquisition.

In an observational study of Veterans Affairs (VA) HCV clinical registry data on 128,769 patients, McCombs et al found that those who achieved an undetectable HCV viral load had a decreased risk of subsequent liver morbidity and death. [42, 43] Viral load suppression reduced the risk for future liver events by 27% (eg, compensated/decompensated cirrhosis, HCC, or liver-related hospitalization), as well as reduced the risk of death by 45%, relative to patients who did not achieve viral load suppression. [42, 43] Additionally, patient race/ethnicity and HCV genotypes affected the risk of future liver events and death. The risk for all liver events and death was higher in white patients relative to black patients, and those with HCV genotype 3 had a higher risk for all study outcomes compared to patients who had HCV genotype 2 (lowest risk) or genotype 1. [42, 43]

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