“Hepatitis C causes inflammation of the liver,” says Marie Laryea, MD, an associate professor of gastroenterology and hepatology in the department of medicine at the University of Rochester Medical Center in New York. “If the hepatitis C is chronic, the liver lays down scar tissue, which eventually leads to cirrhosis. Many people associate [this condition] with alcohol, but many things can cause cirrhosis, hep C being one of them.” According to the Centers for Disease Control and Prevention, 5 to 25 percent of people diagnosed with hepatitis C will develop cirrhosis within 10 to 20 years. Those who have both hep C and cirrhosis are also more likely to develop liver failure or liver cancer. There are ways to treat both hepatitis C and cirrhosis as well as keep your liver healthy. Here’s what you need to know.
The signs and symptoms of cirrhosis don’t appear for years.
Cirrhosis is known as a “silent disease.” That’s partly because the liver is efficient at its job. “You likely won’t have symptoms until cirrhosis is pretty well established, which means your liver is below 25 percent function,” says Dr. Laryea. Plus, the early symptoms that do appear, including fatigue or a poor appetite, are too subtle and nonspecific to be immediately connected to liver disease. The signs and symptoms of advanced cirrhosis include jaundice (a yellow tint to the skin and the whites of the eyes), bruising and bleeding easily, a bloated belly, itchy skin, dark urine, and swelling in the lower legs, ankles, or feet, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). “Patients may also experience hepatic encephalopathy, which is basically a change in the way the brain works that’s related to the liver,” says Laryea. “It’s a slowing of mental faculties akin to a sleeping pill effect.”
Everyone with hepatitis C should be screened for cirrhosis.
Just because you aren’t experiencing symptoms of cirrhosis doesn’t mean you don’t have the disease. “Looking at you from the outside may not tell us what’s happening on the inside,” says Laryea. Tests may include blood work to assess liver enzyme levels; imaging tests, such as an MRI, ultrasound, or CT scan; or a liver biopsy to analyze the level of liver scarring or confirm cirrhosis if an imaging test is inconclusive, says the NIDDK. “When we find someone has [the] hepatitis C infection, our goal is to cure them,” says Nancy Reau, MD, a professor of transplant hepatology and gastroenterology at Rush University Medical Center in Chicago. If your follow-up screening has ruled out cirrhosis, your outlook is positive. “After you’re cured [of hep C] and healthy, the risk of other liver complications is almost zero,” she says. You won’t need continued monitoring. If you are diagnosed with cirrhosis, you’ll likely need a liver ultrasound twice a year, along with blood work to monitor the disease, says Laryea. Treating the hep C virus also allows your liver function to stabilize and even improve somewhat, adds Dr. Reau. “Even with cirrhosis, the risk of bad complications improves monumentally once you cure hepatitis C,” she says.
Your doctors will target the underlying cause of cirrhosis.
Unfortunately, there is no treatment that will reverse cirrhosis. “There is some evidence that after treating hep C, some of the scar tissue may improve, but the global thinking is that for most patients, this is a permanent condition,” says Laryea. Rather, doctors will treat the cause of cirrhosis, which should prevent the disease from getting worse. Beyond that, doctors will treat the complications of cirrhosis with medications that reduce fluid buildup or improve brain function. A liver transplant treats liver failure, not cirrhosis, says Laryea. “There are lots of people who have cirrhosis who do not need a liver transplant, because their liver is still working well,” she says. But if the disease is advanced and liver function dips below 25 percent, you may be a candidate for a transplant.
You can minimize the damage from cirrhosis by adopting healthy lifestyle habits.
If you’ve been diagnosed with hepatitis C, your first priority is to get treated for the virus. Beyond that, there are several habits that can help shore up your liver health. One of the biggest: Stop smoking. “We know specifically with hep C that smoking seems to accelerate scar tissue in the liver,” says Laryea, “but after hep C is cured, we don’t know the role cigarette smoking plays in any future damage.” You should also be vaccinated against hepatitis A and hepatitis B. (There’s no vaccine for hepatitis C.) Changing your change lifestyle habits may also help slow down liver damage. “It’s best to be proactive about your health and do a lot of maintenance,” says Laryea. This may mean cutting alcohol out of your diet, according to Mayo Clinic. Sustaining healthy cholesterol and blood sugar levels through diet, exercise, and weight management is also key. “Metabolic syndrome — high blood pressure, blood sugar, cholesterol, and triglycerides and excess belly fat — puts you at risk for fatty liver disease, which is very similar to alcoholic liver disease,” she says. Your goal is to not have these extra stresses on your liver at this time. Laryea also tells people to reduce their intake of refined sugars, eat a Mediterranean-style diet (whole grains, olive oil, fruits and vegetables, legumes, and some lean meats and dairy), and find time for daily exercise (walking counts). Remember, “What’s good for the whole body is also good for your liver,” says Reau.
