Prognosis

Globally, approximately 244,000 people died from hepatitis C in 2022, mostly from cirrhosis and hepatocellular carcinoma.[7][8]

In the US, the age-adjusted mortality rate increased each year from 2010 through 2013 but began to decline from 2014. The age-adjusted mortality rate decreased from 4.13 per 100,000 population in 2017 to 2.89 in 2022 per 100,000 population.[99]​ There were 12,717 hepatitis C-related deaths reported in 2022.[15]

In the UK, deaths are at their lowest in 10 years (0.44 deaths per 100,000 population in 2022 compared to 0.69 deaths per 100,000 in 2015).​​​[16]

One European study showed that 5-year survival was 91% and 10-year survival was 79% among patients who had hepatitis C and compensated cirrhosis.[63][100] Among patients with compensated cirrhosis, decompensation develops in 18% at 5 years and in 30% at 10 years.[101][102] For patients with decompensated cirrhosis, 5-year survival is only 50%. Although rare, relapse can occur after sustained virological response.[103]

An Italian study of nearly 200 hepatitis C virus (HCV)-infected people with compensated cirrhosis prospectively followed for 14 years showed that the mortality risk is about 2.5% per year, but double that (5% per year) with oesophageal varices at baseline. It also confirmed that genotype 1b, the most common genotype worldwide, is associated with an increased risk of hepatocellular carcinoma, liver decompensation, and mortality.[104] Genotype 3 is likewise associated with an increased risk of cirrhosis and hepatocellular carcinoma.[105]

One population-based study in the US found that excess mortality risk in HCV-infected patients may be due to modifiable health risk behaviours (i.e., smoking, alcohol or illicit drug use, physical inactivity, and unhealthy diet) than it was to HCV infection.[106]

Re-infection

  • Re-infection is defined as the recurrence of HCV viremia after a previously cleared infection. HCV infection does not confer protective immunity. Therefore, people who have cleared a previous infection, either spontaneously or after successful treatment, remain at risk for re-infection, particularly if they have ongoing risk factors for infection.

  • The incidence of re-infection is thought to be low, especially in the era of direct-acting antivirals. Re-infection rates are higher in people who inject drugs, men who have sex with men, people with HIV co-infection, and those with recent HCV infection.[107][108][109][110]

Re-activation

  • ​​​There are a few case reports of HCV reactivation in patients taking immunomodulatory/immunosuppressive drugs. Further data are required before recommending routine screening or monitoring of HCV in these situations.[111][112]

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