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Chronic hepatitis C
Last reviewed: 05.07.2025
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Chronic hepatitis C is the outcome of acute hepatitis C, the chronicization of which is observed in 75-80% of cases. Compared with other pathogens of viral hepatitis, HCV has the highest chroniogenic potential.
It is HCV infection that is the main cause of the formation of the entire group of chronic liver diseases - chronic hepatitis, cirrhosis and hepatocarcinoma. Chronic hepatitis C is always potentially dangerous.
[ What causes chronic hepatitis C?
Hepatitis C virus was identified in 1989 by Houghton et al. It often leads to the development of chronic hepatitis, which can progress to liver cirrhosis and hepatocellular cancer. The transition from acute viral hepatitis C to chronic is observed in 50-80%.
Hepatitis C virus is the cause of more than 90% of cases of post-transfusion hepatitis and cirrhosis worldwide. According to the US National Institute of Health, acute post-transfusion hepatitis C develops in 6.1% of patients who received blood or blood components during cardiac surgery, and becomes chronic in 60%. Of the 39 patients observed for 1-24 years, cirrhosis developed in 8 (20%). It is believed that the average period before cirrhosis develops is about 20 years.
Observation of patients with HCV infection caused by the introduction of virus-containing immunoglobulin in Germany showed that of 56 of them, 52 (92.9%) had anti-HCV in their serum after 6-12 months, and 9-10 years after the introduction of immunoglobulin, anti-HCV was present in the serum of 45 of 65 examined patients. However, 10 years after infection, chronic disease did not develop in most patients, and antibodies were not detected later.
Observation of patients with post-transfusion or household-acquired HCV infection shows that 67% of infected individuals have elevated ALT activity after 6 months or more. In individuals with high serum transaminase activity and the presence of anti-HCV, the virus (HCV-RNA) is usually detected in the blood.
In the United States, 30% of liver transplants are performed due to chronic HCV infection.
Worldwide, the role of HCV as a cause of chronic liver disease and hepatocellular carcinoma appears to be as significant as that of HBV. In some countries, such as Japan, HCV may be even more important.
The ability of HCV to cause persistent infection may be due to its extremely high mutation rate and the formation of multiple quasispecies that differ only slightly in genomes. In many patients, the clinical course and biochemical activity indicators are characterized by ups and downs, suggesting that HCV may have the ability to suppress the immune response.
Symptoms of Hepatitis C
Chronic hepatitis C is a sluggish disease that lasts for many years. An acute attack usually goes unrecognized and occurs without clinical symptoms that could predict chronicity. However, 80% of patients develop chronic hepatitis and 20% develop liver cirrhosis.
Where does it hurt?
What's bothering you?
Diagnosis of hepatitis C
- Complete blood count: anemia, increased ESR. With the development of bone marrow hypo- or aplasia, pancytopenia is observed.
- General urine analysis: no significant changes. Bilirubin may appear in the urine, and if glomerulonephritis develops, proteinuria may appear.
- Blood biochemistry: moderate and transient hyperbilirubinemia with an increase in conjugated and unconjugated fractions; increased activity of aminotransferases, organ-specific liver enzymes (ornithine carbamoyltransferase, arginase, fructose-1-phosphate aldolase), y-glutamyl transpeptidase; decreased albumin content and increased y-globulin.
- Immunological blood test: possible decrease in the number and function of T-suppressor lymphocytes, increase in the content of immunoglobulins, and, in the case of development of extrahepatic systemic manifestations, detection of circulating immune complexes.
- Serological markers of HCV infection: during the active phase of the disease during exacerbation of chronic hepatitis C, markers of the replication phase are detected - HCV-RNA, anti-HCVcoreIgM.
In most patients, histological examination of liver biopsy reveals stepwise necrosis, less often bridge-like necrosis, intralobular and portal lymphohistiocytic infiltration.
Ultrasound and radioisotope scanning reveal diffuse liver enlargement of varying degrees and often splenomegaly.
Diagnosis of chronic hepatitis C
What do need to examine?
Who to contact?
Hepatitis C: Treatment
Rest, diet, or vitamins have no therapeutic effect. Elderly patients with post-transfusion chronic hepatitis C usually die from other causes before liver failure develops. These patients need attention and psychological support. Others need antiviral therapy, usually with lymphoblastoid or recombinant interferon-a. A persistent effect is manifested by normalization of ALT activity, disappearance of HCV-RNA 1 year after stopping interferon treatment, and a decrease in the activity of the process in the liver according to histological examination. In the case of a partial effect of treatment, normalization of ALT activity is not determined, but only its decrease.
More information of the treatment
Drugs
What is the prognosis for hepatitis C?
Chronic hepatitis C has a very variable prognosis. In some cases, the pathological process in the liver has a benign course with spontaneous improvement within 1-3 years, while in others, progression with transformation into liver cirrhosis is observed. According to a study conducted in Italy, 77% of 135 patients with post-transfusion hepatitis developed chronic hepatitis.
By the end of the 15-year period, 65 patients had liver biopsies that revealed cirrhosis. Half of the patients with cirrhosis developed life-threatening complications.