Watch Out for These 6 Hep C Complications

From gallstones to cancer, there are some serious complications associated with hepatitis C. We asked experts to explain what can be done to prevent them.

by Judy Koutsky Health Writer

The Hepatitis C virus (HCV) is a liver infection that affects 2.4 million people in the U.S. There is no vaccine to prevent HCV, so the best way to stay healthy is by avoiding behaviors that are responsible for its spread (through blood; often from infected needles).

Unfortunately for half the people who are infected with HCV each year, it becomes a chronic condition. Why? Because most people with HCV don’t feel sick (that’s why testing is so important). By the time symptoms do appear, it’s often a sign that the infection has led to advanced liver disease, which is not curable and will need to be managed for life. And while not all HCV causes complications—especially when it’s caught and treated early—chronic HCV can cause a host of add-on problems. We asked our experts to explain what they are, when they might happen, and what can be done about them.

Gallstones

The Hep C Connection

“Gallstones are hardened deposits of cholesterol that can form in your gallbladder,” says Douglas Dieterich, M.D., director of the Institute for Liver Medicine in the Department of Medicine at Mount Sinai School of Medicine, New York, NY. “They range in size from as small as a grain of sand to as large as a golf ball. Some people develop just one gallstone, while others develop many gallstones at the same time.”

In people with HCV, bile, a fluid made by the liver, cannot properly flow to the gallbladder, according to the National Institutes of Health (NIH), resulting in the development of gallstones. Symptoms of gallstones include sudden and intense pain in the belly.

What Can Be Done About It?

“Your doctor will determine your treatment for gallstones based on your symptoms and the results of diagnostic testing," says Dr. Dieterich. "The treatments include surgery to remove the gallbladder (cholecystectomy) or if one cannot undergo surgery, medications will be prescribed to dissolve them.”

Liver Cancer

The Hep C Connection

Hep C damages your liver in an ongoing, chronic way, and every time your liver goes to repair itself, there is a risk for a cell mutation to occur, upping your risk for liver cancer. The American Cancer Society (ACS) notes that in the United States, HCV is the most common risk factor for liver cancer. The ACS projects that over 42,000 new cases will be diagnosed in 2021, with over 30,000 Americans dying from the disease. Liver cancer rates have more than tripled since 1980 and death rates have more than doubled during this time period.

What Can Be Done About It?

The challenge with treating liver cancer is that symptoms often do not appear until the later stages of the disease. Symptoms include yellowing of the skin, swelling and pain in the belly area, and feeling very full after a small meal. If your doctor suspects you may have liver cancer, she may screen for it by taking blood and doing an ultrasound.

Dr. Dieterich notes that the treatment options generally depend on the size and the number of tumors in the liver: “That’s why we say that the best treatment for liver cancer is appropriate surveillance, which means keeping your ultrasound appointments so we can catch cancer when it is most treatable.”

Cirrhosis

The Hep C Connection

According to the U.S. Department of Health and Human, HCV left untreated can lead to cirrhosis, which is a condition where the liver slowly breaks down until it’s unable to function. Healthy liver tissue is replaced with scar tissue and the blood flow to the liver is partly blocked. In the early stages of cirrhosis, the liver still works, but in later stages the liver simply can’t function. “About 5% to 20% of people with chronic hepatitis C will develop cirrhosis,” says Dr. Dieterich. In fact, according to the National Liver Foundation, HCV is the most common cause of cirrhosis, while alcohol remains the second most common cause.

What Can Be Done About It?

Most people with cirrhosis have no symptoms. “Unfortunately, cirrhosis of the liver in a majority of the cases cannot be reversed,” says Javeed Siddiqui M.D., chief medical officer at TeleMed2U. “This is why it is critical to treat patients with chronic active hepatitis C as soon as possible. Again, with the latest medication, we can treat hepatitis C in as little as 8 weeks with a 98% cure rate and with little to no side effects from the medications.”

By treating HCV in those people with cirrhosis, the cirrhosis can be prevented from getting worse. Dr. Dieterich notes that lifestyle changes like avoiding alcohol, not smoking, losing weight, and practicing good hygiene to reduce the possibility of infection are also helpful in preventing cirrhosis from getting worse.

Liver Failure

The Hep C Connection

In this case, years of HCV have caused too much scar tissue in your liver and it has become severely damaged to the point that it can’t work properly anymore. “Liver failure can cause a variety of symptoms including jaundice, bleeding, ascites and altered mental status,” says Hwan Y. Yoo, M.D., from the Institute for Digestive Health and Liver Diseases, Mercy Medical Center in Baltimore, MD.

What Can Be Done About It?

According to Dr. Dieterich, the only effective treatment at this point is a liver transplant. During this surgical procedure, doctors will take out the diseased liver and replace it with a whole or partial liver. In most cases, the healthy liver comes from an organ donor who just died, but it also can come from a family member or someone who is unrelated to you but is a good blood type match. Those who donate part of their liver can still lead healthy lives as the healthy liver can regenerate and grow back to its normal size.

Enlarged Blood Vessels

The Hep C Connection

Enlarged blood vessels are the result of blood buildup happening due to damaged liver tissue that interferes with blood flow. As your blood vessels enlarge, they become structurally less stable, raising the risk that they could burst and cause internal bleeding. The name for these enlarged blood vessels is varices, and they often develop in people with HCV and liver issues.

What Can Be Done About It?

While there is no way to prevent these varices from forming, doctors use blood pressure medication (called non-selective beta-blockers) to reduce the risk of bleeding. The Mayo Clinic notes that once a bleeding episode happens, there's an increased risk of it happening again. Excessive blood loss can lead to shock, and even death. In addition to blood pressure medication, an endoscopy may be performed to help stabilize the varices and prevent them from bleeding.

Drug Sensitivity

The Hep C Connection

“Many prescriptions and over-the-counter medications are metabolized by the liver,” explains Dr. Siddiqui. This means that the liver breaks down the medication into a usable form. However, in chronic HCV patients and those suffering from cirrhosis, the liver can no longer do its job effectively. As a result, medications can stay in your system longer, which can ultimately damage to the liver.

What Can Be Done About It?

There are many so-called liver cleanse supplements that claim to remove toxins from your liver and restore liver function. “Unfortunately, these supplements usually lack rigorous scientific investigation and often claim far more than they can achieve,” explains Dr. Siddiqui. He says that if these supplements were able to actually do the things they claim they can, then they would be a mainstay of therapy. Instead, these supplements can possibly cause more drug sensitivity and side effects. “Patients with advanced liver disease should be careful about taking any drugs, especially supplements or so called liver cleansers,” says Dr. Yoo. Consult your doctor instead.

Judy Koutsky
Meet Our Writer
Judy Koutsky

Judy Koutsky is an award-winning writer and editor and her work has appeared in over 30 publications including Conde Nast Traveler, Travel + Leisure, Parents, WebMD, Prevention and Scholastic. You can see her work at JudyKoutsky.com or follow her on Instagram @JudyKoutsky.