Disease progression

A minority of people will clear HCV infection without treatment. It has typically been assumed that approximately 80 to 90% of infected individuals go on to develop chronic or ongoing HCV infection (lasting more than six months), but recent studies have found higher rates of spontaneous HCV clearance.1 2 3  An Australian study found that as many as 42% of HIV-negative IDUs spontaneously cleared HCV within two years of becoming infected; clearance was not associated with specific demographic, behavioural, or clinical factors.4 However, other studies have found higher likelihood of spontaneous clearance in women, Caucasians, people co-infected with hepatitis B virus, and those with acute HCV infection symptoms (possibly because this indicates a stronger immune response); and lower likelihood in men, those of black race, heavy alcohol users, and those co-infected with HIV.5 3 6

A form of acute liver damage called fulminant hepatitis, characterised by massive necrosis (cell inflammation and death), can lead to rapid liver failure and death. This condition can occur in the acute phase of hepatitis A or B or, rarely, hepatitis C, or may be caused by drugs or other toxins. The only treatment for fulminant hepatitis is a liver transplant.

Some HCV-infected individuals will develop progressive liver disease, including severe fibrosis, cirrhosis, liver cancer, and end-stage liver disease (ESLD) (see Fibrosis and cirrhosis). This occurs in an estimated 10 to 25% of HIV-negative people, usually over the course of ten to 40 years.7 A large French study found that the average time from infection to cirrhosis was 30 years.8 The varying severity of disease may reflect differences between HCV strains or differing genetic, immunological, or behavioural characteristics. In the French study, progression was associated with age older than 40 years at the time of infection, daily alcohol consumption of 50g or more, and male gender. The average time to the development of fibrosis among men infected after the age of 40 was 13 years, while women who were infected before the age of 40 and did not drink alcohol took an average of 42 years to progress to fibrosis.

Many studies have shown that heavy alcohol consumption is strongly associated with liver disease progression, but the impact of light consumption (less than 50g, or one standard drink, per day) remains unclear.9 10 In women, heavy drinking can completely eliminate the survival advantage that women otherwise have over men.

Liver disease progression is more likely and occurs more rapidly in HIV/HCV-co-infected individuals (see How does HIV affect hepatitis C?).

References

  1. Bhagani S et al. Acute hepatitis C virus (HCV) in a cohort of HIV-positive men: outcomes and response to pegylated interferon-alpha2b and ribavirin. Tenth Anniversary British HIV Association Conference, Cardiff, abstract 020, 2004
  2. Gilleece Y et al. Transmission of hepatitis C virus among HIV-positive homosexual men and response to a 24-week course of pegylated interferon and ribavirin. J Acquir Immune Defic Syndr 40: 41-46, 2005
  3. Nelson M et al. Increasing incidence of acute hepatitis C in HIV positive men secondary to sexual transmission, epidemiology and treatment. Ninth European AIDS Conference, Warsaw, abstract F12/3, 2003
  4. Jauncey M et al. Clearance of hepatitis C virus after newly acquired infection in drug users. J Infect Dis 190: 1270-1274, 2004
  5. Gerlach et al. Acute hepatitis C: High rate of both spontaneous and treatment-induced viral clearance. Gastroenterol 25: 80-88, 2003
  6. Piasecki BA et al. Influence of alcohol use, race, and viral coinfections on spontaneous HCV clearance in a US veteran population. Hepatology 40: 892-899, 2004
  7. Thomas DL et al. The natural history of hepatitis C virus infection. JAMA 284: 450-456, 2000
  8. Poynard T et al. Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METAVIR, CLINIVIR, and DOSVIRC groups, 1997
  9. Córdoba J et al. Driving under the influence of minimal hepatic encephalopathy. Hepatology 39: 599-601, 2004
  10. Monto A et al. Risks of a range of alcohol intake on hepatitis C-related fibrosis. Hepatol 39: 826-834, 2004
This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.