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[Extrahepatic manifestations of hepatitis C infection]
1Abteilung Gastroenterologie und Hepatologie, Medizinische Hochschule Hannover.
Insights
Hepatitis C virus (HCV) is linked to several conditions outside the liver, including cryoglobulinemia and glomerulonephritis. Further research is needed to clarify HCV
Area of Science:
- Hepatology
- Virology
- Immunology
Context:
- The hepatitis C virus (HCV) is known to cause liver disease but is also associated with numerous extrahepatic manifestations.
- The precise etiological and pathogenetic roles of HCV in these associated conditions are not fully understood.
- Established associations include mixed cryoglobulinemia, membranoproliferative glomerulonephritis, and porphyria cutanea tarda.
Purpose:
- To review the spectrum of extrahepatic manifestations associated with hepatitis C virus infection.
- To discuss the current understanding of the etiological and pathogenetic links between HCV and various non-hepatic diseases.
- To provide guidance on the clinical approach for patients presenting with potential HCV-related extrahepatic conditions.
Summary:
- Hepatitis C virus infection is unequivocally associated with mixed cryoglobulinemia, membranoproliferative glomerulonephritis, and porphyria cutanea tarda.
- Associations with other conditions like panarteriitis nodosa, Sicca syndrome, aplastic anemia, lichen planus, lymphoma, and neuropathies are observed but require further investigation into etiological and pathogenetic roles.
- The autoimmune nature of these extrahepatic diseases in the context of HCV infection remains an open question.
Impact:
- Highlights the importance of considering HCV infection in patients with unexplained extrahepatic diseases.
- Recommends serological testing for HCV antibodies and RNA in relevant clinical settings.
- Suggests discussing antiviral therapy if a causal link between replicative HCV infection and extrahepatic manifestations is established.
Abstract:
The hepatitis C virus is associated with various extrahepatic manifestations. It is unequivocal that hepatitis C is associated with mixed cryoglobulinemia, membranoproliferative glomerulonephritis, and in Southern Europe to some extend also with porphyria cutanea tarda. The rare combination of hepatitis C and panarteriitis nodosa is still questionable. The Sicca syndrome also seems to be associated with hepatitis C virus, but this is not the typical Sjögren syndrome. It is still unclear whether the rare combination of hepatitis C with aplastic enemia has pathogenetic aspects. Although an epidemiological association of hepatitis C with lichen planus, lymphoma, neuropathies and other diseases has been observed, the etiological role and the pathogenetic involvement of the hepatitis C infection remains unclear. Furthermore, the question whether these extrahepatic diseases observed are autoimmune diseases remains open. Concerning the practical approach in a clinical setting, it has to be pointed out that with these diseases a hepatitis C infection has to be considered and testing for hepatitis C antibodies and, if positive, hepatitis C-RNA is indicated. If there will be any evidence of an etiological association of a replicative hepatitis C infection and the mentioned extrahepatic diseases antiviral medication should be discussed.