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Chronic hepatitis C: prognosis
Medical expert of the article
Last reviewed: 06.07.2025
The prognosis for chronic hepatitis C is highly variable. In some cases, the disease has a benign course with spontaneous improvement within 1-3 years, while in others, progression with transformation into liver cirrhosis is observed. According to a study conducted in Italy, 77% of 135 patients with post-transfusion hepatitis developed chronic hepatitis. By the end of the 15-year period, cirrhosis was detected in 65 patients during liver biopsy. Half of the patients suffering from cirrhosis developed life-threatening complications. According to Japanese authors, 20-25 years pass before cirrhosis develops after post-transfusion hepatitis, and about 30 years pass before hepatocellular carcinoma develops. In patients with post-transfusion chronic HCV infection treated in specialized centers in the United States, the disease was progressive and led to death from liver failure and hepatocellular carcinoma.
In general, despite the biochemical and histological signs of liver disease, chronic hepatitis C has a long-term prognosis, since it is asymptomatic, and liver failure develops at a late stage.
The link between HCV infection and hepatocellular carcinoma has been established in studies conducted in Spain, Italy, Japan and the USA.
Unfavorable prognostic factors include very high serum transaminase activity, presence of active cirrhosis on liver biopsy, “viral load” (high HCV-RNA level), genotype 1b, and some comorbidities such as alcoholic liver disease or HBV infection. A positive HCV-RNA test after completion of interferon therapy indicates a high probability of relapse.
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