Clinical

Extrahepatic manifestations common in patients with chronic HCV

Last Updated: 2008-01-29 14:17:18 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Extrahepatic manifestations are prevalent in Bulgarian patients with chronic hepatitis C infection, particularly in those with long-standing infections and those with advanced liver fibrosis, according to a recent study.

Most such manifestations are the consequence of impaired lymphoproliferation and are associated with cryoglobulin production, the study team reports in the December 28 issue of the World Journal of Gastroenterology. At least some patients present with extrahepatic manifestations even in the absence of a clear clinical presentation of hepatic disease.

Dr. Diana V. Stefanova-Petrova of University Hospital Alexandrovska, Sofia, Bulgaria, and colleagues reviewed the medical records of 136 patients with chronic hepatitis C virus (HCV) infection who were referred to that hospital between 1996 and 2004. The most common reason for referral was elevated liver enzymes.

At least one extrahepatic symptom or comorbidity was identified in 104 (76.5%) of the patients. The most frequent clinical manifestation was fatigue (59.6%), followed by kidney impairment (25.0%), type 2 diabetes (22.8%), paresthesia (19.9%),and arthralgia (18.4%). Other associated conditions were palpable purpura, predominantly of the lower extremities (17.6%), lymphadenopathy (16.2%), pulmonary fibrosis (15.4%), thyroid dysfunction (14.7%), Raynaud's phenomenon (11.8%), B-cell non-Hodgkin's lymphoma (8.8%), sicca-syndrome (6.6%), and lichen planus (5.9%).

Laboratory findings showed these patients had cryoglobulinemia (37.5%), thrombocytopenia (31.6%), antinuclear antibodies (ANA) (18.4%), anti-smooth muscle antibodies (ASMA) (16.9%), anti-neutrophil cytoplasm antibodies (ANCA) (13.2%) and anti-cardiolipin antibodies (8.8%). The ANA, ASMA and ANCA were present in low titers.

The factors most significantly associated with extrahepatic manifestations were long duration of HCV infection (at least 20 years versus less than 20 years, P = 0.001) and advanced liver fibrosis (Metavir F4, P = 0.011).

The findings are consistent with those previously published on French, Italian and American HCV patients and also suggest that "the dose of the virus and the route of transmission may be important factors associated with extrahepatic manifestations," Dr. Stefanova-Petrova and associates point out.

The researchers note that "physicians should be aware of the extrahepatic signs and symptoms of HCV infection" and should test for HCV in all patients with these manifestations.

World J Gastroenterol 2007;13:6518-6528.