Disease Progression

The symptoms of hepatitis C are difficult to recognize, for they are progressive in nature and often very mild, at least in the early stages of infection. For more than six months following initial infection, the disease is virtually undetectable.

The most common symptom, commencing sometimes years after initial infection, is fatigue. Other symptoms include mild fever, muscle and joint aches, nausea, vomiting, loss of appetite, vague abdominal pain, and sometimes diarrhea. Many cases go undiagnosed because the symptoms are suggestive of a flu-like illness which just comes and goes, or these symptoms are so mild that the patient is unaware of anything unusual. A minority of patients notice dark urine and light colored stools, followed by jaundice in which the skin and whites of the eyes appear yellow. Itching of the skin may be present. Some people may lose 5 to 10 pounds.

Individuals infected with HCV are often identified because they are found to have elevated liver enzymes on a routine blood test or because a hepatitis C antibody is found to be positive at the time of blood donation. In general, elevated liver enzymes and a positive antibody test for HCV (anti-HCV) means that an individual has chronic hepatitis C. A

very small percentage of patients may recover from acute hepatitis C, but their anti-HCV test will remain positive.

Low level infection, in which the infected individual is virtually asymptomatic but still highly contagious, may continue for years, even decades, before progressing significantly. However, more than 80% of infected individuals eventually progress to the chronic stage of the disease, which seems to eventually result in cirrhosis (scarring of the liver tissue), and end-stage liver disease. This appears to take, on average, about 20 years to develop.

At this point, the symptoms are commensurate with liver disease or liver failure, including jaundice and abdominal swelling (due to fluid retention called ascites), depending on the severity of the liver disease and whether or not cirrhosis has developed. Some patients with cirrhosis do well over time, while others die in 10 and sometimes 5 years. Disorders of the thyroid, intestine, eyes, joints, blood, spleen, kidneys and skin may occur in about 20% of patients. Primary liver cancer can also develop from hepatitis C, a late risk factor which seems to be present 30 years or so after infection.