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Chronic hepatitis C: symptoms
Last reviewed: 04.07.2025
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Chronic hepatitis C may be asymptomatic, i.e. completely asymptomatic, and the diagnosis is usually established during examination of blood donors or routine biochemical testing. Such patients are characterized by prolonged periods of normal serum transaminase activity, despite the existence of histologically confirmed chronic hepatitis. Persistence of serum HCV-RNA may be noted.
Weakness is the main symptom of chronic hepatitis C. Feeling unwell is noted periodically.
Targeted questioning may reveal risk factors such as blood transfusions or intravenous drug use. Risk factors may be absent.
Symptoms of chronic hepatitis C are slow and are accompanied by significant fluctuations in transaminase activity over many years. Each increase in transaminase activity probably reflects an episode of viremia, which can be caused by different quasispecies. Liver failure develops only after 10 years or more from the onset of the disease. Before this, many patients, especially those who have undergone blood transfusions, die from other causes. Obvious signs of portal hypertension are rare; splenomegaly is detected in only half of patients by the time of treatment. Bleeding from esophageal varices is characteristic of the late stage of the disease. Thrombocytopenia develops with an enlarged spleen.
An objective examination reveals short-term jaundice, hemorrhagic phenomena (hemorrhagic rash on the skin), and subfebrile body temperature. An examination of the abdominal organs reveals hepatomegaly (the enlarged liver is dense and painful), and often splenomegaly.
In the clinical picture of chronic hepatitis C, numerous extrahepatic symptoms should be taken into account (vasculitis, membranoproliferative glomerulonephritis, cryoglobulinemia, pneumofibrosis, Sjogren's syndrome, late cutaneous porphyria, uveitis, keratitis). In recent years, the development of bone marrow aplasia in hepatitis C has been reported, mainly in patients of Asian origin. Extrahepatic symptoms of chronic hepatitis C are due to the ability of the hepatitis C virus to extrahepatic replication, and kidney damage is due to HCV-Ag-containing immune complexes circulating in the blood.
[ Extrahepatic symptoms of chronic hepatitis C
Symptoms of chronic hepatitis C may be accompanied by various immune disorders.
Approximately one third of patients with essential mixed cryoglobulinemia have markers of HCV infection. Serum contains complexes including HCV virions and HCV antigen-antibody. HCV antigen is also found in liver tissue and skin. Clinically, HCV infection manifests as systemic vasculitis with purpura, neuropathy, and Raynaud's syndrome (in a small proportion of patients). Some patients respond to interferon therapy.
In membranous glomerulonephritis, glomerular immune complexes containing HCV, anti-HCV, IgG, IgM, and rheumatoid factor are detected. Interferon therapy may be effective.
Lymphocytic sialadenitis has been described, resembling Sjogren's syndrome, but without the features of dry syndrome.
An association with thyroiditis has been noted, even in patients not treated with interferon.
A close association with porphyria cutanea tarda has also been found; HCV may be a trigger in predisposed individuals.
Lichen planus is associated with chronic liver disease, including hepatitis C.
The combination with alcoholic liver disease is manifested by more pronounced viremia and more severe liver damage.