Factors affecting progression


Alcohol significantly speeds up the rate at which hepatitis C damages the liver. Research has clearly shown that the severity of liver disease in those with hepatitis C is much higher among those who consume alcohol. This has been seen in rates of fibrosis, development of cirrhosis, incidence of liver cancer and finally survival rates. Studies have conclusively revealed that a daily alcohol intake of more than 4-5 units significantly affects progression. Whether it is safe to consume any alcohol is uncertain, but doctors will generally advise people with hepatitis C to abstain from alcohol completely.


People over 40 are progressively more susceptible to faster rates of fibrosis. This is due to the decrease in blood flow within the liver that occurs as people get older (meaning the liver is not operating at its optimum level). As age increases, immunity levels also decrease, as does the ability the person has to make full use of antioxidants. This is true whether you become infected with hepatitis C after the age of forty or if you already had the disease for some time before.


Whatever their age, men are more likely to experience a faster progression towards cirrhosis than women. It is believed that this is because oestrogen prevents some aspects of fibrosis development. The scarring progression can speed up for women after the menopause when oestrogen production decreases.

Lack of anti-oxidants

A healthy liver is equipped with a range of anti-oxidants. These chemicals protect the liver from the damaging effect of oxygen free-radicals, which are the by-products and waste from cellular and metabolic processes. In chronic liver disease there seems to be a significant depletion of anti-oxidants. This is important because a surplus of oxygen free-radicals can create a condition known as oxidative stress, which is associated with the progression of fibrosis.

Co-infection with HIV and hepatitis B

HIV and hepatitis C co-infection causes faster progression of liver damage. Research conducted in the USA has also indicated that in some cases co-infection of HIV and hepatitis C genotype 1a can also speed up the progression towards AIDS. Co-infection with hepatitis B can increase the possibility of developing liver cancer.

Fatty liver

Fat accumulates in the liver if it is unable to metabolize it properly. This is normally due to liver damage or excessive intake of fat through diet. This is called ‘steatosis’. This accumulation of fat can also cause inflammation, which in turn may lead to more scarring.