There’s a reason the hepatitis C virus is called “the silent killer.” All too often, people don’t realize they’ve been infected. Out of the estimated 2.4 million people in the United States who have hepatitis C, more than half don’t know they have the virus, according to the U.S. Department of Health and Human Services.
“Usually when someone gets infected with hepatitis C, they [have no symptoms] until the disease gets fairly advanced,” says Hardeep Singh, MD, a gastroenterologist and hepatologist at St. Joseph Hospital in Orange, California. “The median time it takes for symptoms to develop is 30 years.”
While close to half of people who contract hepatitis C are able to clear the virus on their own, the other half require treatment. And more than half of those diagnosed will go on to develop long-term, or chronic, hepatitis C, according to the Centers for Disease Control and Prevention (CDC). Over time, untreated hepatitis C can cause cirrhosis (hardening and scarring of the liver), which can cause complications that can eventually lead to liver failure.
The damage caused by cirrhosis and liver failure usually can’t be reversed; sometimes an organ transplant is the only treatment option once advanced liver damage occurs. With hepatitis C, the risk of liver cancer also rises.
Because hepatitis C symptoms are silent for so long, people sometimes see their doctor for a complication, such as type 2 diabetes, only to discover later on that their condition was partly caused by hepatitis C, explains Dr. Singh.
Hepatitis C Attacks More Than Your Liver
In the early stages of cirrhosis, the liver can still perform most of its functions, but as cirrhosis worsens, it can cause complications, including:
Type 2 diabetes Up to 20 percent of people with chronic hepatitis C also have type 2 diabetes, partly because the virus may cause insulin resistance, according to a study published in January 2020 by the journal Clinical Diabetes. The virus may trigger diabetes, but having diabetes can also worsen your hepatitis C, including increasing the risk of cirrhosis and liver cancer, particularly if you don’t treat either condition.
Luckily, having type 2 diabetes and hepatitis C won’t lessen the effects of direct-acting antivirals, the 2020 study found.
Still, it’s important to ask the doctors who treat your hepatitis C and diabetes to closely coordinate your treatment plan, so you can manage both conditions. You should also make necessary lifestyle changes to keep your blood sugar levels stable, such as eating small, frequent meals and snacks that are low in fat and refined carbs.
Treating and clearing a hepatitis C infection also improves insulin sensitivity in among those who have high insulin resistance, according to a study published in April 2022 in the journal Frontiers in Endocrinology, which may decrease your risk of developing type 2 diabetes.
Harm to blood vessels and joints Hepatitis C can cause cryoglobulinemia, which — for about 1 in 3 people who’ve finished antiviral therapy — can continue to appear even after treatment, according to a study published in May 2022 in the journal Plos One. Cryoglobulinemia is a condition in which abnormal proteins form in your body, leading to inflammation and blood vessel damage. The most common symptoms are purpura (small red, purple, or brown spots on the skin from ruptured blood vessels); joint pain; peripheral neuropathy (nerve damage in the hands, arms, legs, and feet); and Raynaud’s syndrome (cold and numbness in the fingers and toes), notes a case report published in April 2022 by the Journal of Community Hospital Internal Medicine Perspectives.
Rheumatoid arthritis (RA) This type of arthritis develops in some people with hepatitis C, and can cause pain, fatigue, swelling, and joint stiffness. These symptoms can even appear before you realize you have hepatitis C, according to the American College of Rheumatology. The good news is that your RA symptoms will often improve when your hepatitis C is treated.
Depression and other mental health problems About 35 percent of people with hepatitis C also have depression, according to a study published in May 2022 by the Journal of Clinical Medicine, though this figure drops to less than 20 percent among those who receive treatment for the virus. It’s true that the stress of living with the virus can negatively impact your mental health, but there are other causes at work, too. For example, cirrhosis can lead to a buildup of toxins in your brain, which can cause hepatic encephalopathy, a condition that leads to confusion and disorientation, according to Cleveland Clinic. The good news is that many of these psychiatric and neurological problems improve with antiviral medication.
Damage to kidney function “Any chronic liver disease that leads to cirrhosis can affect the kidneys and lead to kidney failure,” says Singh. In fact, hepatitis C is common among people undergoing kidney dialysis and kidney transplantation, according to a review published in July 2022 by the journal Cureus. And the combination of hepatitis C and chronic kidney disease is linked to increased rates of sickness and even death.
Hepatitis C itself may lead to kidney issues in several ways. You may develop glomerulonephritis, a condition that affects the part of the kidney that filters waste from your bloodstream. If left untreated, this can cause your kidneys to shut down. Hepatitis C may also increase your risk of end-stage renal (kidney) disease, according to a study published in the World Journal of Hepatology.
Rare bone disease You could develop a bone condition called osteosclerosis, though it’s very rare. The illness involves extremely fast bone turnover, which leads to severe, deep bone pain. Only people with hepatitis C develop this condition, and just 22 cases have been identified by researchers since 1992, according to a case study published in February 2021 by the journal Calcified Tissue International.
There’s Reason for Hope With Hepatitis C
Unfortunately, even when people are diagnosed with hepatitis C, many don’t do anything about it. According to the CDC, of people with hepatitis C who have private health insurance, only about a third receive medical care for their condition.
Yet Singh says he’s seeing more people with hepatitis C than ever before, as people are finding out that new treatment options often work well. “New treatments for hepatitis C have been revolutionary,” he says. “Over 95 percent of patients can be cured with three months of treatment.”
Newer antiviral drugs can clear the virus even if you’ve had no luck with earlier medications. They also generally take less time to start working, cause fewer side effects, and can treat and even eliminate illnesses caused by hepatitis C.
The CDC recommends that all Americans over age 18 get screened at least once. Pregnant women should be tested during each pregnancy. People who inject drugs, share needles, or have received maintenance hemodialysis are also at risk. If you are in one of these higher-risk groups, you should be tested routinely. Talk to your primary care doctor if you haven’t yet been screened yet or are at increased risk.
If you do test positive and get treated, keep in mind that damage from cirrhosis usually can’t be reversed, Singh says. Following treatment, you’ll be monitored closely for liver cancer and other health problems.
