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Clinical manifestations and natural history of chronic hepatitis C virus infection

Sanjiv Chopra, MD, MACP
Section Editor
Adrian M Di Bisceglie, MD
Deputy Editor
Allyson Bloom, MD


Following infection with the hepatitis C virus (HCV), chronic infection typically occurs, with approximately 50 to 85 percent of cases developing chronic hepatitis. However, chronic HCV infection is usually slowly progressive and may not result in clinically apparent liver disease in many patients. Approximately 5 to 30 percent of chronically infected individuals develop cirrhosis over a 20- to 30-year period of time.

In the United States, chronic HCV is the most common cause of chronic liver disease and the most frequent indication for liver transplantation.

This topic will review the clinical features associated with chronic HCV infection and factors associated with the progression of chronic liver disease. Acute HCV infection and the epidemiology, diagnosis, and treatment of chronic HCV infection are discussed separately. (See "Epidemiology and transmission of hepatitis C virus infection" and "Screening for chronic hepatitis C virus infection" and "Diagnosis and evaluation of chronic hepatitis C virus infection" and "Overview of the management of chronic hepatitis C virus infection".)


The vast majority of patients with chronic HCV infection are minimally symptomatic, although fatigue is a common complaint. Even if cirrhosis develops, many patients have only nonspecific symptoms. Occasionally, patients have extrahepatic findings (such as cryoglobulinemia, renal disease, or specific dermatologic disorders) that are directly related to HCV infection.

Generalized symptoms — Most patients with chronic infection are asymptomatic or have only mild nonspecific symptoms [1]. Among those who have symptoms, the most frequent complaint is fatigue; other less common manifestations include nausea, anorexia, myalgia, arthralgia, weakness, and weight loss. The symptoms are rarely incapacitating and may be difficult to ascribe to liver disease alone (rather than to another illness such as depression); nevertheless, they may lead to a decrease in the quality of life [2], which may in part be accounted for by awareness of infection [3], and which can be improved following successful treatment [4]. (See "Patient evaluation and selection for antiviral therapy for chronic hepatitis C virus infection", section on 'Rationale for treatment'.)

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Literature review current through: Nov 2017. | This topic last updated: Dec 07, 2017.
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