9 Ways Hepatitis C Affects Your Body
Ongoing inflammation is hepatitis C’s signature move. But it’s often a sneaky one, meaning many people living with the chronic liver condition known as hep C don’t show any symptoms at all. If this inflammation goes unchecked, it can lead to serious liver damage, scarring (called cirrhosis), and possibly even liver failure. Over time, untreated hepatitis C can cause complications throughout the whole body. But before we get into those specifics, let’s cover some important background.
What Exactly Is Hepatitis C?
Hepatitis C is a liver infection caused by the hepatitis C virus (also known as HCV) and is transmitted through the blood. Most people become infected with the virus by sharing needles or other equipment to prepare or inject drugs, getting tattooed or pierced with an unsterile needle, and sometimes by sharing personal care items that may have come into contact with someone’s blood, such as razors or toothbrushes. Hepatitis C may also be transmitted through unprotected sex.
Acute Versus Chronic Hepatitis C
The hepatitis C virus has two stages: acute and chronic. The acute stage happens within six months of being exposed to the virus, and if you’re among the lucky minority, your body will clear the infection during the acute phase and that’s as far as it goes. But according to the Centers for Disease Control and Prevention (CDC), more than 50% of people who are infected will develop chronic hepatitis C, meaning the virus makes itself at home in your body and silently infiltrates the liver until it’s eventually discovered and treated.
How a Healthy Liver Works
To understand the effects of liver damage, it’s helpful to know what the liver does. “The liver has multiple responsibilities,” says Saira Aijaz Khaderi, M.D., a liver disease expert and assistant professor of surgery at Baylor College of Medicine in Houston, TX. “It makes proteins that help clot blood. It makes bile, which is important for digestion. It helps store sugars and releases them for energy. And it helps break down fats and produce cholesterol.” If that’s not enough, your liver also filters your blood to clear it of poisonous substances.
How Hepatitis C Damages the Liver
HCV infects and kills hepatocytes, or the cells in the liver, explains Geoffrey D. Block, M.D., medical director of liver transplant at the University of Arizona College of Medicine in Tucson. This sets off an inflammatory response. As the liver works in overdrive to create more healthy cells and release immune cells (cytokines) to fight the virus, scar tissue accumulates. Over time, a continued immune response causes so much scar tissue to build up that the liver can’t function properly—called cirrhosis. When that happens, the following nine complications can pop up.
You Feel Fatigued
All those immune cells swirling around your body trying to fight off inflammation in your liver can make you feel downright crummy, like you have a cold or even the flu. “Some people feel a little run down and just say they don’t have as much energy,” Dr. Block says. These symptoms are pretty unspecific and can overlap with other conditions, so it’s not likely you’d recognize these feelings and quickly connect them to your liver. But many people do report feeling less fatigued when they undergo treatment, Dr. Khaderi adds.
A healthy liver acts as your body’s detox system, swiftly filtering toxins from your blood. When your liver is damaged, certain chemicals can accumulate and cross the blood-brain barrier, says Dr. Khaderi. The result: A condition called hepatic encephalopathy, which causes confusion, memory problems, and coma in extreme cases. It can develop slowly or occur quickly without any warning. “Often, family members will notice signs first,” Dr. Khaderi says. As many as 70% of people with cirrhosis develop symptoms, though most are mild.
Bleeding in the Digestive Tract
“Think of the liver as a sponge,” Dr. Block says. “Blood from the spleen, pancreas, and intestines all go into it, so there’s a really large volume of blood flow through the organ. When the liver becomes cirrhotic, it’s stiffer and harder but the same amount of blood still has to go through.” This creates backpressure, or hypertension, in nearby veins. In turn, this hypertension can cause vessels in areas like the esophagus, stomach, and rectum to enlarge and spontaneously rupture and bleed, Dr. Block explains.
Your Gut Is Swollen
Increased blood pressure in the blood vessels can also cause fluids to back up in the abdominal cavity, Dr. Khaderi says. This is known as ascites. “It can be a small amount, but people can also carry as much as 16 liters of fluid,” she explains. “It gets very uncomfortable. The fluid pushes up on the lungs—though it isn’t in the lung—preventing them from expanding fully when taking a deep breath, so people can feel short of breath. It also compresses the stomach, so people may find they feel full and can’t eat as much.”
You Have Trouble Absorbing Nutrients
One of the liver’s main jobs is to produce bile, a fluid that helps with digestion. More specifically, bile breaks down fats into fatty acids that your body can absorb through the intestines and use for energy. Bile also carries waste products to the intestines to be eliminated. But when the liver is obstructed by scar tissue, bile can’t be produced or used properly. As a result, your intestines can’t absorb fats or fat-soluble vitamins (vitamins A, D, E, and K) the way they should, leading to nutrient deficiencies.
You Bleed Easily
“As liver disease gets progressively worse, the liver’s ability to produce a variety of proteins that circulate in the blood, including clotting factors, is reduced,” says Dr. Block. This may cause you to bleed more easily. For example, you may accidentally cut your gums when brushing your teeth or having trouble stemming the bleeding if you scrape your knee. Typically, this only happens in advanced stages of liver failure—meaning you’re at the point where you may need a transplant.
Your Skin and Eyes Are Yellow
Bile contains a yellowish waste product called bilirubin, which naturally forms when old red blood cells break down. Normally, the liver helps filter out bilirubin so it can be excreted when you go to the bathroom. But when you have cirrhosis, it isn’t properly removed and instead, bilirubin levels in the blood increase, Dr. Khaderi explains. This can cause jaundice, a condition where the skin and eyes take on a yellow tinge.
You Have Dry Eyes and Cotton Mouth
If all this isn’t enough to worry about, hepatitis C has also been associated with dry eyes and mouth, Dr. Khaderi says. (You may also notice that you have a bad taste in your mouth and musty breath.) These complications are collectively referred to as “sicca” symptoms. It’s not totally clear why it happens, but research suggests it may be due to the immune response that’s triggered by the chronic inflammation in the body, as well as how HCV impacts the salivary glands.
Your Blood Sugar Is High
If you have hep C, you’re also at risk for type 2 diabetes. That's because HCV triggers an inflammatory response that interferes with your body's ability to use insulin correctly—what doctors call “metabolic signaling.” This results in insulin resistance, causing glucose to build up in the blood and leading to type 2 diabetes. The important thing to know, if you have any of these symptoms, is that there is a cure for hep C. Though best if treated early, late is better than never, so head to your doctor, stat!
Hepatitis C Causes: Centers for Disease Control and Prevention. (2020). “Hepatitis C Questions and Answers for the Public.” cdc.gov/hepatitis/hcv/cfaq.htm#D1
Hepatitis C Symptoms and Causes: Mayo Clinic. (n.d.) “Hepatitis C.” mayoclinic.org/diseases-conditions/hepatitis-c/symptoms-causes/syc-20354278
Hepatic Encephalopathy: National Organization of Rare Disorders. (2011). “Hepatic Encephalopathy.” rarediseases.org/rare-diseases/hepatic-encephalopathy/
Bile: U.S. National Library of Medicine: Medline Plus. (2020). “Bile.” medlineplus.gov/ency/article/002237.htm
Nutrient Absorption Problems: Merck Manuals. (2019). “Cirrhosis of the Liver.” merckmanuals.com/home/liver-and-gallbladder-disorders/fibrosis-and-cirrhosis-of-the-liver/cirrhosis-of-the-liver
Skin Discoloration from Jaundice: U.S. National Library of Medicine: Medline Plus. (2020). “Jaundice.” medlineplus.gov/ency/article/000210.htm
Dry Mouth and Hepatitis C: Saudi Journal of Gastroenterology. (2013). “Oral Conditions Associated with Hepatitis C Virus Infection.” ncbi.nlm.nih.gov/pmc/articles/PMC3958971/#__ffn_sectitle
Insulin Resistance and Hepatitis C: American Association for the Study of Liver Diseases. (2018). “The Link Between Hepatitis C Virus and Diabetes Mellitus: Improvement in Insulin Resistance After Eradication of Hepatitis C Virus.” aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/cld.694