prognosis

Last edited 07/2020 and last reviewed 07/2020

Acute HCV hepatitis may cause:

  • aplastic anaemia - usually within 3-6 months of infection
  • agranulocytosis
  • peripheral neuropathy

Acute hepatitis C takes a chronic course in 50-70% of cases (1)

  • hepatic fibrosis progresses is dependent on the age of the patient at the time of infection
  • on average, 20–30% of patients develop cirrhosis within 30 years
  • progression of fibrosis is modulated by cofactors such as the amount of alcohol consumed or viral coinfections (e.g., with HIV)
  • patients with HCV-associated cirrhosis have a 3–6% incidence of hepatocellular carcinoma

By 2018, the number of liver transplant registrations and transplants undertaken in those where post-HCV cirrhosis and hepatocellular carcinoma (HCC) is given as the indication for transplant, fell by 44% and 29% respectively when compared to pre-2015 levels, although both showd a rise over the previous year (by 19% and 13% respectively).

Deaths from HCV-related end stage liver disease (ESLD) and hepatocellular cancer (HCC) have been falling since 2014, with a decline of 20% by 2018 from the 2015 World Health Organization (WHO) baseline.

Over the period 2015 to 2018

  • a 37% decline in crude mortality rates,
  • and a 34% decline in adjusted mortality rates, is observed among those with an HCV diagnosis reported to PHE
  • linkage study suggests high levels of alcohol consumption, with 60% of deaths in those with HCV reported to Public Health England (PHE) over the last 10 years also having an alcohol-related cause of death noted on the death certificate

When compared to 2015, mortality rates for all HCV-associated mortality in 2016, 2017 and 2018 reduced by 13.2%, 21.4% and 37.4% respectively (all p<0.03)

  • when assessing mortality from HCC and ESLD specifically
  • mortality rates from HCC (hepatocellular carcinoma) were similar in 2016 and 2017 when compared to 2015 (both p>0.8)
    • however rates in 2018 were 18.1% lower (p=0.03)
  • for ESLD (end stage liver disease), mortality rates reduced by 18.5%, 36.2% and 53.9% in 2016, 2017 and 2018 respectively (all p<0.03) when compared to 2015

Reference:

  • Zeuzem S. Treatment Options in Hepatitis C -The Current State of the Art. Dtsch Arztebl Int. 2017 Jan; 114(1-2): 11–21.
  • NICE (October 2000). Guidance on the use of Ribavirin and Interferon Alpha for Hepatitis C.
  • PHE (2020). Hepatitis C in England 2020 - Working to eliminate hepatitis C as a major public health threat.