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Extrahepatic manifestations of chronic viral hepatitis
1Division of Hepatology, Center for Liver Diseases, University of Miami School of Medicine, 1500 NW 12th Avenue, Suite 1100, Miami, FL 33136, USA.
Insights
Hepatitis B (HBV) and C (HCV) infections cause liver disease and various extrahepatic manifestations. Early recognition of these autoimmune-related complications is crucial for diagnosis and treatment, despite limited therapeutic effectiveness.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Hepatitis B (HBV) and Hepatitis C (HCV) are primary causes of chronic liver disease, cirrhosis, and hepatocellular carcinoma.
- These viral infections are also linked to a range of extrahepatic manifestations, impacting various organ systems.
- While uncommon, these extrahepatic complications can lead to significant morbidity and mortality.
Purpose of the Study:
- To highlight the spectrum of extrahepatic manifestations associated with HBV and HCV infections.
- To emphasize the importance of recognizing these conditions for timely diagnosis and management.
- To discuss the potential autoimmune basis of these extrahepatic complications.
Main Methods:
- Review of existing literature on HBV and HCV-associated extrahepatic manifestations.
- Compilation of reported clinical conditions linked to these viral infections.
- Analysis of the potential pathogenic mechanisms, particularly autoimmune phenomena.
Main Results:
- HBV is associated with skin rash, arthritis, glomerulonephritis, polyarteritis nodosa, and papular acrodermatitis.
- HCV is linked to cryoglobulinemia, glomerulonephritis, autoantibodies, idiopathic thrombocytopenic purpura, lichen planus, Mooren's ulcer, Sjögren's syndrome, porphyria cutanea tarda, and vasculitis.
- The majority of these extrahepatic manifestations are believed to stem from autoimmune processes.
Conclusions:
- HBV and HCV infections extend beyond liver pathology, presenting with diverse extrahepatic manifestations.
- Awareness of these extrahepatic conditions is critical for effective patient care.
- Further research into the pathogenesis is needed, as current treatments for these manifestations are not always effective.
Abstract:
Hepatitis B (HBV) and C (HCV) viruses are well-recognized causes for chronic hepatitis, cirrhosis, and even for hepatocellular carcinoma. Apart from liver disease, these viral infections are known to be associated with a spectrum of extrahepatic manifestations. The prevalence of clinically significant extrahepatic manifestations is relatively low, but it can be associated with significant morbidity and even mortality. An awareness and recognition of these manifestations is of paramount importance in facilitating early diagnosis and in offering treatment. However, treatments are not necessarily effective, and patients may continue with disabling extrahepatic manifestations. Hepatitis B virus has been well recognized as causing a variety of manifestations that include skin rash, arthritis, arthralgia, glomerulonephritis, polyarteritis nodosa, and papular acrodermatitis. More recently, infection with hepatitis C virus has elicited considerable interest for its role in a spectrum of extrahepatic manifestations. Among the best-reported are cryoglobulinemia, glomerulonephritis, high titer of autoantibodies, idiopathic thrombocytopenic purpura, lichen planus, Mooren's corneal ulcer, Sjögren's syndrome, porphyria cutanea tarda, and necrotizing cutaneous vasculitis. The precise pathogenesis of these extrahepatic complications has not been determined, although the majority represent the clinical expression of autoimmune phenomena.