The Health Effects of Untreated Hepatitis C

Millions of people in the U.S. are living with hepatitis C. If you have recently been diagnosed with hepatitis C, you might be wondering about your options. And you may have heard about direct-acting antiviral therapies (DAAT), which can cure hepatitis C. 

But do you really need treatment for hepatitis C? And what happens if you decide not to take DAAT? Let’s take a look at how untreated hepatitis C can affect your liver and the rest of your body. 

What happens when Hepatitis C goes untreated?

Hepatitis C is an infection the hepatitis C virus causes. You may have heard that when some people get exposed to the hepatitis C virus, their immune system is able to fight off the virus. In these cases, people get sick with symptoms of acute hepatitis C, then the virus goes away completely. But this only happens about 20% to 30% of the time. 

For the most part, people who get exposed to the hepatitis C virus develop chronic hepatitis C, a long-term infection. Over time, chronic hepatitis C injures and scars the liver. It can also affect other parts of the body and lead to medical problems, like liver cancer and diabetes. 

Before DAAT, having chronic hepatitis C could mean a lifelong battle against liver failure and other medical problems. But thanks to DAAT, people with hepatitis C can get treatment early on and avoid serious liver problems.

How does untreated chronic hepatitis C affect the liver?

The hepatitis C virus is one of five types of viral hepatitis. These viruses attack the liver and enter liver cells. Once inside the liver cells, the hepatitis C virus starts to reproduce itself and causes inflammation and damage in the process. Let’s take a closer look at what liver inflammation and damage can mean.

Cirrhosis

The hepatitis C virus damages liver cells over time. At first, the liver is still healthy enough to try to heal itself from this damage. But each time the liver gets attacked and damaged, it develops a scar. This scarring is called “fibrosis.” Over time, scar tissue replaces more and more of the healthy liver tissue. Liver cirrhosis occurs when scar tissue takes over a lot of the liver.

Scar tissue can’t do the jobs of healthy liver tissue. So as scar tissue replaces healthy liver tissue, the liver stops working properly. 

Up to 1 out of 4 people with hepatitis C develop cirrhosis. This usually takes between 10 and 20 years. But some people with hepatitis C develop cirrhosis faster than others. This occurs more often in males and people over 50 years old when they developed chronic hepatitis C. It’s also more likely in someone if they have: 

• A history of heavy alcohol use

• Hepatitis B 

• HIV

There’s no way to reverse liver cirrhosis, and there’s no treatment that can replace scar tissue with healthy liver tissue. That’s why it’s so important to stop the damage as soon as possible by starting DAAT. 

Liver failure 

The liver is a strong organ. Even when scar tissue takes it over, the liver still tries to work. But that can change at any point. People living with cirrhosis can develop liver failure. This is a serious condition where the liver completely stops working. In the end, it’s a deadly condition. There’s no way to reverse liver failure once it has developed.   

People living with cirrhosis have about a 5% chance of developing liver failure every single year. Studies show that if someone develops liver failure, the risk of dying in the next 12 months is 15% to 20%. 

Once someone has developed liver failure, the next option for treatment is a liver transplant. 

 Studies show that DAAT can still help when someone develops liver failure from untreated hepatitis C. While DAAT can’t cure liver failure, they can delay or even prevent the need for a liver transplant. 

Liver cancer

Untreated hepatitis C can also lead to liver cancer. That’s because the hepatitis C virus can change the genes in the liver cells. The risk for developing liver cancer goes up as someone develops cirrhosis. People with cirrhosis have between a 1% to 4% chance of developing liver cancer every year.

How does untreated chronic hepatitis C affect the rest of the body?

Untreated hepatitis C infection can lead to other medical conditions besides liver disease. In fact, more than ⅓ of people with chronic hepatitis C end up with a condition that affects something else besides the liver. 

Studies show that people with untreated hepatitis C often develop:

• Diabetes: People with untreated hepatitis C are more likely to develop diabetes. Researchers are not sure why this happens, but they believe it’s because the virus increases insulin resistance. 

• Lymphoma: Untreated hepatitis C can lead to lymphoma as well as liver cancer. 

• Eye conditions: Research has linked hepatitis C to several eye conditions, including dry eye, corneal ulcers, and uveitis.

• Arthritis: Hepatitis C can cause joint inflammation and trigger an immune system response, which can lead to rheumatoid arthritis. 

• Cardiovascular disease: Chronic hepatitis C directly damages blood vessels. Over time this can lead to cardiovascular disease.

• Kidney disease: Chronic hepatitis C can cause a sudden kidney injury by inflaming the kidney’s blood vessels. It can also lead to chronic kidney disease by attacking the kidney’s filtration system.

• Brain fog: People with chronic hepatitis C often report symptoms of brain fog, including trouble with memory and concentration. 

Does hepatitis C treatment prevent complications?

Hepatitis C treatment can prevent liver damage, liver failure, cancer, and other conditions related to hepatitis C. DAAT consists of oral medications that can cure hepatitis C. About 90% of people with hepatitis C are cured after a 8 to 12 week course of DAAT. 

If you have hepatitis C, do not wait. Talk to your healthcare provider about starting DAAT as soon as possible.

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Written by:

Brian Clista, MD

Dr. Clista is a board-certified pediatrician who works in private practice in Pittsburgh, Pennsylvania. He previously served as a National Health Service Corporation Scholar in the inner city of Pittsburgh for 11 years.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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