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How does hepatitis C affect the liver?

The hepatitis C virus usually evolves slowly, causing liver damage over a long period of time – sometimes decades – but may progress more quickly than commonly thought. While it is usually symptomless at the outset, it is one of the world’s main causes of cirrhosis and primary liver cancer.1

During this time, a person may not show any symptoms. This is known as being ‘asymptomatic’. So, for some people, by the time hepatitis C is detected they already have advanced liver disease.

How quickly liver damage develops depends on a number of factors, such as:1-3

  • Age at infection
  • Length of time infected 
  • Gender (sex)
  • Race
  • Lifestyle
  • Other infections
What can happen if hepatitis C is not treated?

The longer that hepatitis C goes untreated, the greater the risk of significant liver damage becomes.

Liver damage can occur as:1

  • Fibrosis, in which the liver becomes scarred
  • Cirrhosis, in which largely irreversible scarring replaces normal liver tissue and affects how well the liver works

A ‘fatty liver’, which can occur with obesity or alcohol-associated liver disease, can speed up the liver damage caused by
hepatitis C. Co-infection with other hepatitis viruses (hepatitis A or B) can also increase the extent of liver damage.1

Liver transplantation

Eventually, some people with hepatitis C need a liver transplant.1
In people that have not cleared the virus before receiving a liver transplant, it is common for the hepatitis C virus to return.1

Liver cancer

Every year up to 5% of people with cirrhosis go on to develop a type of liver cancer called hepatocellular carcinoma.4 Eliminating the hepatitis C virus from the body reduces or even reverses liver damage, which in turn can reduce the risk of liver cancer.5


  1. World Health Organization, Hepatitis C. 2002. Available at:
  2. Poynard T et al. Lancet 1997; 349: 825-832.
  3. Crosse K et al. Clin Gastroenterol Hepatol 2004; 2: 463-468.
  4. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatitis C virus infection. J Hepatol. 2011;55: 245–264.
  5. Teoh NC, Farrell GC. Intern Med J. 2004;34(6):324-337.



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