HCV is the most common cause of liver related deaths in the United States. HCV causes liver injury and fibrosis. This worsens over 20-40 years and progresses to cirrhosis. A cirrhotic liver is hard and nodular. It cannot function normally and causes progressive fatigue. Eventually, patients develop liver failure or liver cancer. About 2% of patients with cirrhosis develop liver cancer each year. About 3% of patients with cirrhosis progress to liver failure each year. Liver cancer is detected on ultrasound, CT or MRI scans of the liver. Liver failure exhibits many symptoms and signs. Fluid accumulates in the abdomen called ascites. It can become infected, spontaneous bacterial peritonitis (SBP). Jaundice is yellow color of the skin and eyes. The urine is dark and stools are light in color. Low testosterone causes sexual dysfunction in men. Ammonia levels are increased in the blood along with other neurotoxins. Forgetfulness, sleep disturbance and confusion are the result Bizarre behavior, DUI arrests and even coma can be experienced.
Portal hypertension is a complication of cirrhosis. Blood from the intestines carry nutrients to the liver through the portal vein. The pressure in this vein is usually very low. When the liver is hard and nodular the blood cannot flow through it normally. The pressure in the portal vein rises to high levels. This causes the spleen to become congested and enlarged. Enlarged veins in the esophagus and stomach form called varices. Varices should be suspected when the platelet count falls to less than 110,000 or when there is ascites, jaundice or visible veins in the abdominal wall. Since these varices can rupture and bleed, patients with cirrhosis need upper endoscopy. Esophageal band ligation can treat varices and prevent rupture.
The best way to avoid misery from HCV is to cure it before there is too much liver damage. Fibrosis stage ranges from 0 (normal) to cirrhosis (stage 4). Stage 0,1,2 and most stage 3 patients do well. Once the patient has stage 4 cirrhosis, the clock is ticking faster. Curing HCV allows healing from stage 1,2 and 3 back to stage 0 or 1. About half of cirrhotic patients will also heal back to a lower stage if the HCV is cured.
Survival is improved with cure of HCV. Less than 2% of Americans die from liver disease, while one third of HCV patients die from liver cancer or liver failure. They were diagnosed and or cured too late to prevent premature death. Get your loved ones tested and if positive make sure that they are treated and cured.