Symptoms and Complications

After an incubation period of 6-8 weeks, the acute phase of the disease lasts approx 2-3 years. Unlike hepatitis A (HAV) or HBV, the patient is usually asymptomatic; therefore, the disease is often missed unless the individual has reported a specific exposure and is being monitored. Other cases are found by chance, when raised liver enzymes are found on a routine blood test.

A "silent phase" follows the acute phase when the virus lies dormant and the liver enzymes are usually normal. This period lasts approx 10-15 years. Reactivation may then occur. Subsequent viral replication damages the hepato-cytes, and liver enzymes rise to moderate or high levels.

Eighty percent of individuals who are HCV antibody-positive are infectious, regardless of the levels of their liver enzymes. Approximately 80% of people develop chronic infection, one-fifth of whom progress to cirrhosis. There is a much stronger association with hepatocellular carcinoma than with HBV. An estimated 1.25-2.5% of patients with HCV-related cirrhosis develop liver cancer (18). Less than 2% of chronic cases resolve spontaneously.

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