Cirrhosis occurs when the large amounts of scar tissue form in the liver. The scar tissue, or fibrosis, might result from inflammation or injury. A hepatitis C infection causes the liver to become inflamed and, over time, can cause cirrhosis. Chronic hepatitis C infection is believed to be the most frequent cause of cirrhosis in the world, which means that there is a very close relationship between cirrhosis and hepatitis C.
Hepatitis C is caused by a viral infection. The infection spreads by contact with infected blood or blood products. Injection drug use and sharing improperly sterilized needles are the most common routes of viral transmission. Blood screening procedures have eliminated the risk of contracting the virus from blood transfusions, although that was a risk prior to the early 1990s. Many people with cirrhosis and hepatitis C infection have no known exposure or risk factors.
Most people infected with the hepatitis C virus will not develop cirrhosis. The infection is short-lived in approximately 25 percent of infected people. Acute infection does not cause liver damage. Although hepatitis C is the most common cause of cirrhosis, only about 20 percent of people with chronic hepatitis C infection develop cirrhosis.
Cirrhosis related to hepatitis C takes decades to develop. Prolonged inflammation causes scar tissue, which gradually replaces the healthy live tissue. The hardened scar tissue blocks the flow of blood through the liver and prevents the liver from functioning properly. Whereas a healthy liver can regenerate cells to repair damage, a liver in the late stages of cirrhosis can no longer repair itself.
Certain factors increase a person’s risk for developing cirrhosis and hepatitis C. The most important risk factor is past and current alcohol use. Other factors that accelerate the progression to cirrhosis include an age of more than 45 years and co-infection with human immunodeficiency virus (HIV) or hepatitis B virus. Some people with none of the risk factors have rapidly progressing disease.
Treatment of cirrhosis and hepatitis C depends on the stage. People who have early stage cirrhosis have a good prognosis and might live for several decades with no complications. Treatment in early stages consists of keeping the person healthy for as long as possible and treating complications as they arise. Possible complications include ascites, or fluid build-up in the abdomen; encephalopathy, or a degenerative disease of the brain; or variceal bleeding. Liver transplant is the only treatment for advanced cirrhosis.
The treatment of the underlying hepatitis C infection is of paramount importance to controlling liver inflammation and damage. Pegylated interferon combined with ribavirin is the standard therapy. Ribavirin is an antiviral drug that, by itself, has little effect on the hepatitis virus. When combined with interferon, however, ribavirin becomes two to three times more effective. Pegylated interferon is injected once weekly for 24 or 48 weeks.