Evolution and complications

Approximately 70-80% of hepatitis C infections become chronic (no cure after 6 months). The evolution of hepatitis B depends on age. If the infection occurs in adulthood, it becomes chronic in 5% to 10% of cases. This percentage is much higher in children younger than 5 years old (up to 90% in infants).

If hepatitis C is cured (naturally or following treatment with medication), there is still a risk of reinfection, especially if the risk behaviour continues. For hepatitis B, there is a risk of reactivation, for example if the immune system is weakened.

The most severe form of acute hepatitis is fulminant hepatitis, which can lead to death. The complications of chronic hepatitis are primarily cirrhosis and liver cancer. Co-infections with, for example HIV or HDV, increase the risk of developing a complication.

Cirrhosis of the liver

• Cirrhosis is an irreversible degeneration of liver tissue following repeated damage by alcohol, toxins, viruses, etc.
• It is often a silent disease that is discovered late.
• If there are symptoms, these usually consist of jaundice, tiredness, skin lesions, loss of appetite and weight loss, and at a later stage, fluid build-up in the stomach, as well as heart, kidney and brain damage.
• 10% to 30% of the chronic forms of hepatitis evolve into cirrhosis if the treatment isn’t effective or isn’t followed correctly.

Liver cancer

Liver cancer (=hepatocellular carcinoma) is usually a complication of cirrhosis. Hepatitis B and C can evolve into cancer.

Liver cancer can also result from a localised cancer in another organ, which has spread with metastases (secondary cancers) in the liver.

Fulminant hepatitis

• In rare cases, inflammation of the liver can cause fulminant hepatitis, characterised by a significant loss of liver function.
• Fulminant hepatitis involves mass destruction of liver tissue, which makes anorgan transplant necessary.
• It occurs primarily in people with hepatitis B (and hepatitis D) or toxic hepatitis (through medication or by another means).
• Fulminant hepatitis is fatal for approximately 1 in 4 people in the short term.
• It can cause unexplained bleeds, (red patches on the skin and nose bleeds) and changes in mental state (confusion and sometimes coma).