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Perspective on the Progression of Hepatitis C

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Those with Hepatitis C likely know that their disease can get worse, but may want to know more about the average speed of liver disease progression.

Upon receiving a Hepatitis C diagnosis, learning that the virus progressively damages the liver takes center stage. While there is no formula to compute the speed at which Hepatitis C advances in the body, understanding the stages of illness and whether alcohol is consumed can help someone assess where they lie in the scope of their illness.

Accounting for at least 25 percent of all cases of chronic liver disease, chronic Hepatitis C is a progressive condition. Although a significant portion of those infected have no symptoms, normal liver enzymes and normal liver histology, experts believe the virus still progresses – it just does so more slowly than in others. Because of this steady progression, slowing disease progression is a valid goal in chronic Hepatitis C management.

Once a liver is infected with the Hepatitis C virus, it becomes increasingly damaged. A basic progression of liver disease is described below:

  • Inflammation – As the liver tries to fight infection, the liver becomes inflamed, tender and enlarged.
  • Fibrosis – Known as fibrosis, an inflamed liver will eventually scar. As excess scar tissue grows, it replaces healthy liver tissue, causing a decrease in liver function.
  • Cirrhosis – When the liver becomes so scarred that it can no longer heal itself, cirrhosis has occurred.
  • Liver Cancer – With a liver struggling to perform its job of processing toxins, the ideal environment for cells to mutate into cancer exists.
  • Liver Failure – Once the liver has completely lost its ability to function, the life-threatening condition of liver failure has arrived.

Chronic Hepatitis C progression is typically evaluated in one of three ways:

  1. Retrospectively – A retrospective study identifies patients with established infection and correlates their current stage of liver disease to the duration of their infection. A problematic bias of retrospective studies is their inclination to select participants who have sought medical attention due to their symptoms. Because the actual duration of infection in these patients may be underestimated, disease progression approximates may be inaccurate.
  2. Prospectively – A prospective study looks at an entire group of people with Hepatitis C from the time they first become infected. These studies typically involve those who received contaminated blood, since their time of viral acquisition can be accurately determined.
  3. Retrospectively and Prospectively Combined – Retrospective/prospective studies identify a group of patients who were exposed to Hepatitis C in the past and then follow them prospectively. The advantage of these studies is that there is a head start to the follow-up as compared to a prospective study.

Although the statistics describing Hepatitis C progression are not necessarily straightforward, some generalized assumptions that have resulted from a combination of retrospective, prospective and retrospective/prospective studies include:

  • After acquiring the Hepatitis C virus, it takes an average of between 10 to 14 years for biopsy evidence of chronic hepatitis to appear.
  • After acquiring the Hepatitis C virus, it takes an average of about 20 years to develop cirrhosis.
  • After acquiring the Hepatitis C virus, it takes an average of about 28 years to develop liver cancer.
  • About 10 to 25 percent of people with chronic Hepatitis C develop cirrhosis within 10 to 15 years.
  • While the overall rate of fibrosis progression in people with Hepatitis C is low, it is increased in those who are older or already have fibrosis as indicated on their index biopsy.

The combined results of dozens of studies confirm that the natural progression of the chronic Hepatitis C virus is slow and, in general, complications develop over decades, not years. Although a timeline for how Hepatitis C evolves covers a wide spectrum, scientists agree on three factors that favor rapid progression of the virus: 1.) alcohol use, 2.) co-infection with another hepatitis virus and 3.) duration of infection. While viral genotypes, co-infection with HIV and gender have been suspected of affecting Hepatitis C progression, these claims lack conclusive evidence.

Understanding how liver disease progresses from inflammation to liver failure confirms the importance of maintaining any healthy liver cells. Thankfully, this progression usually takes many years. If you’ve recently acquired Hepatitis C, this affords plenty of time to protect remaining liver cells. However, if you have been living with Hepatitis C for a long time, the only clear instruction is to completely abstain from alcohol, since it is the only definite route for accelerating Hepatitis C progression.

References:

Ryder, SD, MD, Progression of hepatic fibrosis in patients with hepatitis C: a prospective repeat liver biopsy study, Gut, 2004.

www.brown.edu, Hepatitis C: Epidemiology, Brown University, 2008.

www.medicinenet.com, Hepatitis C, MedicineNet Inc., 2008.

www.medpagetoday.com, Mortality from Hepatitis C-Related Disease at Near-Record High, Michael Smith, MedPage Today LLC, March 2008.

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