I was recently diagnosed with Stage 4 cirrhosis of the liver, brought on by past years of drinking as well as a hepatitis C infection. I just had an ultrasound of my liver done ("looked good"), my liver function numbers are low (60-90) and I feel healthy as a horse. I have not drunk alcohol or used drugs in more than eight years. I lift weights and run three miles a day, five days a week. My question is: Are these diseases silently eating away at my liver or, because of my healthy lifestyle, will they remain dormant?

J.H.

Cirrhosis is the end result of chronic scarring that occurs after damage to the liver. Consumption of alcohol is the most common cause of cirrhosis in the United States. Viral hepatitis, most often hepatitis C, can also lead to cirrhosis. Once scarring has occurred in the liver, it generally cannot be reversed. Thus, no matter what the cause, once cirrhosis has developed, there is no way to return the liver to normal.

In your particular case, it is also important to note that when a history of alcohol abuse and hepatitis C are present together, their harmful effects on the liver may be magnified. It is unclear why this occurs. However, it has been proven in many studies that when both of these factors are present, the process leading to cirrhosis is accelerated.

Clearly, abstaining from alcohol and leading a healthy lifestyle is always a good idea for anyone with cirrhosis. In addition, your doctor should monitor your liver's function (via blood tests) on a regular basis. Patients with cirrhosis are also at risk for bleeding from abnormal veins in the esophagus because of the changes in pressure caused by the scarring. An endoscopy is often done to evaluate the esophagus because there are therapies to prevent bleeding if abnormal veins are found. Your diet should also be low in salt because patients with cirrhosis are prone to fluid accumulation if they consume excess salt. In addition, all patients with cirrhosis face an increased risk of developing liver cancer. Screening for this is done via periodic ultrasound and blood tests.

There is some controversy as to whether hepatitis C should be treated in individuals with cirrhosis. Combination drug therapy (interferon and ribavirin) is generally used earlier in the course of hepatitis C infection to prevent cirrhosis. However, there are data to suggest that even if a patient has already developed cirrhosis, drug therapy may lead to fewer complications of the disease. You should discuss the possibility of treating your hepatitis C infection with a gastroenterologist experienced in the latest therapy for the disease.