Hepatitis - Hepatitis C

Symptoms of Hepatitis C

Most patients with hepatitis C do not experience symptoms. If they appear at all, symptoms develop about a month or two after a person is infected. Symptoms of progressive chronic viral hepatitis may be very subtle. In some patients, itchy skin is the first symptom. Overall, fatigue is the most common symptom. Many patients do not experience any symptoms at all. In fact, chronic hepatitis C can be present for 10 to 30 years and in some cases cirrhosis or liver failure can develop before patients experience any clear symptom.

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Some evidence suggests, however, that patients with chronic hepatitis C often experience an impaired quality of life, mostly from fatigue. Fatigue can impair daily function, vitality, and mood in ways that are similar to other chronic diseases. The severity of the fatigue is not necessarily related to the degree of liver injury. Some patients develop pain in small joints in the body (such as the hand) that may be nearly indistinguishable from symptoms of rheumatoid arthritis, fibromyalgia, or carpal tunnel syndrome. Other nonspecific symptoms include abdominal discomfort, loss of appetite, depression and difficulty in concentration.

Outlook for Patients with Hepatitis C

Acute Form. Acute hepatitis C is rarely recognized, since there are no symptoms in up to 80% of these patients. An estimated 15% and 30% of acute cases clear up without becoming chronic. Early treatment with interferons can significantly reduce the risk for progression to chronic hepatitis.

Chronic Form. About 60% to 85% of infected people develop chronic hepatitis. This poses a risk for cirrhosis, liver cancer, or both.

Overall, between 10% and 15% of patients with chronic hepatitis C develop cirrhosis. The risk varies widely, however. It is highest for alcohol users, older men, diabetics, and patients co-infected with hepatitis B or HIV.
Of these patients, 4% eventually develop liver cancer. (Liver cancer rarely develops without cirrhosis first being present.)

Even in patients with cirrhosis, survival rates in one study were nearly 80% at ten years. Still, over 5,000 deaths are currently attributed annually to hepatitis C and the rate continues to climb. Furthermore 140,000 people were hospitalized in 1998 for HCV, leading many experts to believe that hepatitis C is indirectly responsible for many more deaths than reported. [ SeeIn-Depth Report # 75 Cirrhosis.]

Patients with chronic hepatitis C may be also at higher risk for non-liver disorders including the following:

Cryoglobulinemia (a disorder in which protein clumps form in the blood). This can cause skin rash and ulcers, kidney problems, arthritis, and sensations (such as tingling or pain) in the hands and feet. People with such symptoms may have particular difficulties with interferon, which can have similar side effects.
Porphyria cutanea tarda (a disorder which causes skin color and texture changes and sensitivity to light.)
Certain autoimmune disorders, particularly hypothyroidism and rheumatoid arthritis.
Some experts believe that hepatitis C may infect the central nervous system in certain patients, possibly accounting for the fatigue, depression, or both experienced by patients who have even relatively mild cases.
Certain non-Hodgkin's lymphomas.