Extrahepatic manifestations of chronic hepatitis C

TLDR

The study assessed the prevalence of clinical and biologic extrahepatic manifestations of HCV and examined their associations with demographic, biochemical, immunologic, virologic, and histologic factors. Data were collected prospectively from 1,614 chronic HCV patients in a single center, excluding HBV and HIV, and the prevalence of dermatologic, rheumatologic, neurologic, nephrologic, metabolic, and immunologic manifestations was evaluated. Seventy‑four percent of patients had at least one extrahepatic manifestation, with arthralgia, paresthesia, myalgia, pruritus, and sicca syndrome most common, while cryoglobulins (40 %), antinuclear antibodies (10 %), low thyroxine (10 %), and anti‑smooth muscle antibodies (7 %) were the most frequent biologic abnormalities; age, female sex, and advanced fibrosis were the strongest risk factors, and several manifestations were associated with cryoglobulin positivity.

Abstract

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.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.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.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.