Hepatitis C liver damage progression

How the disease progresses varies significantly from person to person. After many years some people will have minimal liver damage with no scarring while others can progress to cirrhosis (extensive scarring of the liver) within less than ten years. On average it takes about twenty years for significant liver scarring to develop. The symptoms experienced and the damage done to the liver vary dramatically from person to person. Some people will have few, if any, symptoms for many years. While for others the symptoms can have quite noticeable effects on their health.

Acute phase

The period immediately following infection is called the ‘acute phase’. This lasts about six months. If the immune system does not manage to clear the virus in this time, the disease is considered to have moved into a long-term or ‘chronic phase’.

  • You can read about possible symptoms during the acute phase here.

Chronic phase

After six months 70% to 85% of those infected will have failed to clear the virus spontaneously. After this period the hepatitis C virus enters what is known as the ‘chronic phase’. This is when hepatitis C becomes a chronic or long-term infection. The diagnosis is confirmed when over a six month period hepatitis C RNA viral presence is detectable on at least two occasions.

A diagnosis of chronic hepatitis C means the battle between the virus and the immune system that occurs during the acute stage has finally been won by the virus. It is now highly unlikely that the virus can be cleared without treatment.

The liver damage due to the virus begins with fibrosis, the build-up of scar tissue in the liver which can then go on to lead to cirrhosis, where areas of the liver cease to function. The liver can only compensate for so much of the liver ceasing to function. This leads to decompensated cirrhosis also called end stage liver disease (ESLD) when the liver ceases to function.

You can read about cirrhosis here.

Within the NHS the extent of liver damage is measured by a Fibroscan, a non-invasive test similar to an ultrasound that measures the stiffness of the liver.

  • You can read more about how the liver is damaged in people living with hepatitis C here.


Fibroscan score

Metavir score

Extent of liver damage


Mild fibrosis


2.5 - 7


F0 –F1


No liver damage up to very mild liver damage.


Significant fibrosis


7 – 9.5




Scarring has built up around the blood supply to the liver.


Severe fibrosis


9.5 – 11.5




The scars around different blood vessels in the liver are joined but liver function is unaffected.


Compensated cirrhosis

11.5 – 29



The scarring is beginning to build up in the tissues of the liver and it's function is impaired. The higher the Fibroscan score the less well the liver will be able to function.


Decompensated cirrhosis


30 and above




The liver can no longer maintain its function due to the extent of the scarring.