Hepatitis C: An In-Depth Guide

Over time, the hepatitis C virus causes inflammation in the liver, destroying healthy liver cells and causing the liver to replace them with scar tissue. This happens in a process called fibrosis. If the virus is left untreated over a long period of time, more of the liver gets replaced with scar tissue until nearly all of the liver is scarred; this is called cirrhosis.

One of the health impacts of cirrhosis is an increased risk of a type of liver cancer called hepatocellular carcinoma. This increased risk of liver cancer is still present after a person is cured of hepatitis C, so ongoing monitoring is recommended.

Compensated and decompensated cirrhosis

Once cirrhosis has developed, it initially results in compensated cirrhosis. In this stage, the liver is still performing many of its functions. Many people with compensated cirrhosis experience few or no symptoms.

However, eventually decompensated cirrhosis develops. Decompensated cirrhosis is when there is so much scar tissue that it is difficult for the liver to function. In this stage, there is a significant risk of life-threatening complications, such as serious abdominal infections, internal bleeding, liver failure and death. With this type of cirrhosis, a liver transplant may be considered.

Hepatitis C treatment and cirrhosis

Hepatitis C treatments are highly effective, including for people with cirrhosis. Before a person receives treatment, their liver health will be assessed to determine whether they have cirrhosis. For more information, see Liver health monitoring tests.

Having cirrhosis can change which treatments are safest and most effective and how long a person needs to take their treatment. A healthcare provider will consider the amount of liver injury a person has when recommending hepatitis C treatment.

Being cured of hepatitis C means that the hepatitis C virus can no longer injure the liver; therefore, it can no longer cause scarring and advance cirrhosis.

Ongoing monitoring for liver cancer after cure

People with cirrhosis have an increased risk of a type of liver cancer called hepatocellular carcinoma even after they are cured. For people with cirrhosis, Canadian hepatitis C treatment guidelines recommend ongoing monitoring for liver cancer using ultrasound every six months. A person with cirrhosis will need ongoing monitoring for liver cancer, even if their liver health im­proves after treatment.

A person without cirrhosis usually does not need specific follow-up for liver cancer screening after being cured of hepatitis C.

Resources for service providers

• Hepatitis C Basics – eduCATIE online course
• Hepatitis C Treatment – eduCATIE online course
• The management of chronic hepatitis C: 2018 guideline update from the Canadian Association for the Study of the Liver – CMAJ treatment guidelines

Resources for clients

• Understanding Cirrhosis of the Liver: First Steps for the Newly Diagnosed – CATIE booklet   
• Hep C can be cured – CATIE brochure
• Curing hepatitis C: What you need to know  - CATIE booklet
• Curing hepatitis C: What you need to know if you use drugs – CATIE booklet

Revised 2020.