The Progression of Hepatitis C: What Are the Stages?

Key takeaways
Every case of hepatitis C begins as an acute infection. Infections that last more than 6 months are considered chronic.
Many people with hepatitis C end up with chronic hepatitis C that can last a lifetime. The consequences of long-term infection include liver damage, liver cancer, and even death.
Early detection and treatment are key for stopping the progression of hepatitis C and avoiding major complications.
Hepatitis C is an infection caused by the hepatitis C virus (HCV) that leads to liver inflammation. Symptoms can be mild for many years, even while liver damage is taking place.
Many people with hepatitis C end up with chronic hepatitis C that can last a lifetime. The consequences of long-term infection include liver damage, liver cancer, and even death.
Early detection and treatment are key for stopping the progression of hepatitis C and avoiding major complications.
How HCV is transmitted
HCV is a bloodborne pathogen. That means the virus is transmitted through contact with blood that contains HCV.
To reduce your risk of exposure:
Avoid sharing razors, nail clippers, toothbrushes, and other personal hygiene items.
Avoid sharing needles, syringes, and other sharps.
Disinfect wounds and surfaces touched by blood and other bodily fluids as soon as possible.
Patronize tattoo and body piercing studios that practice proper sterilization practices.
HCV usually isn't transmitted through sexual contact, but it's possible. Using condoms, gloves, and other barrier methods during sexual activity can help reduce your risk.
Birthing parents with HCV can also transmit the virus during childbirth, but not through nursing.
Early warning signs
In most cases, there are no early warning signs. Most people are symptom-free and remain unaware of the infection. Others experience mild symptoms, such as fatigue and loss of appetite, which tend to resolve independently.
According to the World Health Organization (WHO), around 30% of people clear the infection within 6 months of exposure without medical intervention.
Acute hepatitis C
The acute phase of hepatitis C is the first 6 months after contracting HCV. Early symptoms may include:
fever
fatigue
loss of appetite
nausea and vomiting
In most cases, symptoms clear up within a few weeks. If your immune system doesn't fight the infection on its own, it enters the chronic phase.
Given the vague nature of the symptoms, hepatitis C may go unnoticed for years. It's often discovered during a blood test that's being done for other reasons.
Chronic hepatitis C
Approximately 70% of people will go on to develop chronic hepatitis C. However, even in the chronic phase, it may take years for symptoms to show.
The progression begins with inflammation of the liver, followed by the death of liver cells. This causes scarring and hardening of liver tissue.
Roughly 15–30% of people with chronic hepatitis C go on to develop cirrhosis of the liver within 20 years.
Cirrhosis of the liver
When permanent scar tissue replaces healthy liver cells, and your liver loses the ability to function, it's called cirrhosis.
In this condition, your liver can no longer heal itself. This can cause fluid to build up in your abdomen and the veins in your esophagus to bleed.
When the liver fails to filter toxins, they can build up in your bloodstream and impair brain function.
Cirrhosis of the liver can sometimes develop into liver cancer. This risk is greater in people who drink excess alcohol. Treatment of cirrhosis depends on the progression of the condition.
End-stage hepatitis C
Chronic hepatitis C can cause serious long-term health consequences when it leads to liver scarring. End-stage hepatitis C occurs when the liver is severely damaged and can no longer function properly.
Symptoms may include:
fatigue
nausea and vomiting
loss of appetite
abdominal swelling
yellowing of the skin and eyes (jaundice)
muddled thinking
People with cirrhosis may also experience bleeding in the esophagus, as well as brain and nervous system damage.
A liver transplant is the only treatment for end-stage liver disease.
Factors that affect the progression
Because alcohol is processed in the liver, consumption of excess alcohol can hasten liver damage, so it's important not to drink it. Damage also progresses faster in people with weakened immune systems, such as those with HIV.
People who also have hepatitis B are at an increased risk of developing liver cancer.
Males who have cirrhosis tend to experience faster disease progression than females. People over 40 with cirrhosis also experience faster disease progression than younger people.
If you suspect that you have hepatitis C, consult with a healthcare professional as soon as possible. Early detection and treatment are the best ways to prevent and treat any serious complications or progression.
Frequently asked questions
What is the life expectancy of a person with hepatitis C?
Many people live for years after receiving a hepatitis C diagnosis. Your outlook ultimately depends on the stage at diagnosis, whether liver damage has occurred, and your overall health.
How many people experience long-term complications of hepatitis C?
According to the Centers for Disease Control and Prevention, approximately 5–25 out of every 100 people who have hepatitis C develop cirrhosis within 10–20 years.
People who develop cirrhosis have a 3–6% annual risk of hepatic decompensation or 'decompensated' cirrhosis. This occurs when your liver function decreases and may be a sign of end-stage hepatitis C.
People who develop cirrhosis also have a 1–4% annual risk of developing hepatocellular carcinoma, which is the most common type of primary liver cancer.
What are the chances of dying from hepatitis C?
Hepatitis C alone typically isn't fatal, but complications from untreated or advanced hepatitis C can be. People who develop decompensated cirrhosis, for example, have a 15–20% risk of death within a year of diagnosis.
If you have questions about your outlook, talk with your healthcare professional. They're the only person with direct insight into your diagnosis and medical history.

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