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Extrahepatic manifestations of chronic hepatitis C. MULTIVIRC Group. Multidepartment Virus C
P Cacoub1, T Poynard, P Ghillani
1Department of Internal Medicine, Hôpital La Pitié-Salpêtrière, Paris, France.
Insights
Hepatitis C virus (HCV) infection frequently causes clinical and biologic extrahepatic manifestations, particularly in joints, muscles, and skin. Advanced age, female sex, and liver fibrosis are key risk factors.
Area of Science:
- Hepatology
- Immunology
- Internal Medicine
Background:
- Hepatitis C virus (HCV) infection is associated with a wide range of extrahepatic manifestations.
- Understanding the prevalence and risk factors for these manifestations is crucial for patient management.
Purpose of the Study:
- To determine the prevalence of clinical and biologic extrahepatic manifestations in HCV patients.
- To identify factors associated with these manifestations.
Main Methods:
- Prospective analysis of data from 1,614 chronic HCV patients.
- Assessment of dermatologic, rheumatologic, neurologic, nephrologic, and other manifestations, alongside autoantibodies and cryoglobulins.
- Multivariate analysis to identify associated demographic, biochemical, immunologic, virologic, and liver histologic factors.
Main Results:
- 74% of patients had at least one clinical extrahepatic manifestation.
- Common manifestations included arthralgia (23%), paresthesia (17%), myalgia (15%), pruritus (15%), and sicca syndrome (11%).
- Biologic abnormalities included cryoglobulins (40%), antinuclear antibodies (10%), and low thyroxine (10%).
- Advanced age, female sex, and extensive liver fibrosis were significant risk factors.
Conclusions:
- Extrahepatic manifestations are common in HCV infection, affecting joints, muscles, and skin.
- Mixed cryoglobulins, antinuclear antibodies, and anti-smooth muscle antibodies are frequent immunologic abnormalities.
- Age, sex, and liver fibrosis are key predictors of these manifestations.
Objective:
To assess the prevalence of clinical and biologic extrahepatic manifestations of hepatitis C virus (HCV) infection and to identify associations between clinical and biologic manifestations.
Methods:
To analyze the natural history of extrahepatic manifestations of HCV infection, we reviewed only the data recorded prospectively during the first visit of 1,614 patients with chronic HCV infection, coming from a single monocenter cohort. Exclusion criteria were positivity for hepatitis B surface antigen or human immunodeficiency virus. The prevalence of dermatologic, rheumatologic, neurologic, and nephrologic manifestations; diabetes; arterial hypertension; autoantibodies; and cryoglobulins were assessed. Then, using multivariate analysis, we identified demographic, biochemical, immunologic, virologic, and liver histologic factors associated with the presence of extrahepatic manifestations.
Results:
At least 1 clinical extrahepatic manifestation was observed in each of 1,202 patients (74%). Five manifestations had a prevalence >10%: arthralgia (23%), paresthesia (17%), myalgia (15%), pruritus (15%), and sicca syndrome (11%). Four biologic abnormalities had a prevalence >5%: cryoglobulins (40%), antinuclear antibodies (10%), low thyroxine level (10%), and anti-smooth muscle antibodies (7%). Only vasculitis, arterial hypertension, purpura, lichen planus, arthralgia, and low thyroxine level were associated with cryoglobulin positivity. By univariate and multivariate analyses, the most frequent risk factors for the presence of clinical and biologic extrahepatic manifestations were age, female sex, and extensive liver fibrosis.
Conclusion:
Extrahepatic clinical manifestations are frequently observed in HCV patients and involve primarily the joints, muscles, and skin. The most frequent immunologic abnormalities include mixed cryoglobulins, antinuclear antibodies, and anti-smooth muscle antibodies. The most frequent risk factors for the presence of clinical and biologic extrahepatic manifestations are advanced age, female sex, and extensive liver fibrosis.