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HCV Extrahepatic Manifestation Glossary – NEW!
For a list and short descriptions of HCV Extrahepatic Manifestations visit our new glossary.
The hepatitis C virus mainly affects the liver, but there are many other conditions that are associated with hepatitis C. Extrahepatic manifestation means diseases or conditions that affect organs other than the liver. Extrahepatic manifestations of hepatitis C can be found in the skin, eyes, joints, immune system, nervous system and kidneys. Some of these conditions – cryoglobulinemia, for example – are somewhat more common and well-documented, while others are infrequent or their association with hepatitis C has not yet been proven.
Vasculitis refers to a group of conditions that are characterized by inflammation of the walls of blood vessels; these include the veins, arteries and capillaries. Essential mixed cryoglobulinemia is a blood disorder that is caused by abnormal proteins in the blood called cryoglobulins that precipitate or clump together when blood is chilled and then dissolve when re-warmed.
There is a possible association between hepatitis C (HCV) and Fibromyalgia (FM). Hepatitis C and FM share many symptoms such as fatigue, depression, cognitive issues, muscle and joint pain. The exact association has not been discovered, but many experts believe that HCV may act as a trigger to the onset of FM. Of interest, one study found that people with FM and HCV exhibit symptoms such as inflammation around joints, bursa (sac containing fluid for lubrication of joints) and/or tendons, and vasculitis (blood or lymph vessel inflammation), that are not seen in FM in people without HCV.
Lichen planus is a fairly common skin disorder that lasts for months to years. Lichen planus affects about 1 to 2% of the U.S. population and usually affects people between the ages of 30 and 70 years old. It is slightly more prevalent in women than in men. The exact cause of lichen planus is unknown. However, lichen planus is known to be triggered by stress, genetics, allergic reactions to medicines, and by viral infections such as hepatitis C. The onset may be gradual or fast.
The most common type of glomerulonephritis (a type of kidney disease) found in people with hepatitis C (HCV) is cryoglobulinemic membranoproliferative glomerulonephritis (MPGN). Other less common forms of these types of kidney diseases include non-cryoglobulinemic MPGN, membranous glomerulonephritis, MPGN type III, and mesangial proliferative glomerulonephritis. This article concentrates on MPGN.
There is a strong association between hepatitis C and mixed cryoglobulinemias. Mixed cryoglobulinemias are a devastating disease but if hepatitis C can be identified early on, treated and cured people will not develop them. Mixed cryoglobulinemias is a blood disorder caused by abnormal proteins in the blood called cryoglobulins. The cryoglobulins precipitate or clump together when blood is chilled then dissolve when rewarmed.
Non-Hodgkin’s lymphoma (NHL) is a form of cancer that starts in the lymphatic system. The lymphatic system is a network of lymph vessels that carry a clear fluid called lymph, made up of a type of white blood cells that fight infection. The lymphatic system is a circulatory system that collects white blood cells which are taken from veins, circulated throughout the body, and returned to the bloodstream.
Neuropathy is a medical term for any disease that affects the nerves. There are four major types of neuropathy – polyneuropathy, autonomic neuropathy, mononeuropathy, and the most common form, peripheral polyneuropathy – more commonly called peripheral neuropathy (PN). There are 20 million Americans that have some form of peripheral neuropathy. Peripheral neuropathy can affect nerves throughout the body including the feet, hands, or legs and cause problems with the heart, sex organs and digestive system. In other words, any organ that has nerves can be affected.
Porphyrins are complex molecules in the body that combine with iron to produce heme, which is responsible for giving blood its red color. They combine with globin to form hemoglobin. Porphyria is the name of a group of diseases caused by an excess of porphyrins in the blood. Porphyria Cutanea Tarda (PCT) is one of the most common types of porphyria, triggered by a deficiency of an enzyme called uroporphyrinogen decarboxylase (UROD).
Pruritus is one of the most common symptoms reported by people with hepatitis C (20%), but is more commonly found in people with advanced liver disease and cirrhosis. Pruritus is itching that may be localized to a specific part of the body such as hands and feet, but it can also be a generalized itching all over the body. Some people even report that it feels like their internal organs itch. Pruritus can be related to high bilirubin levels, autoimmune disease or dry skin, and can be a side effect of treatment.
In someone infected with hepatitis C, Raynaud’s phenomenon is caused by HCV-related cryoglobulinemia. The prevalence of Raynaud’s phenomenon in the hepatitis C population is unknown, but it is believed to be an uncommon condition. In people with HCV-related cryoglobulinemia, however, one study found that 30% of people also had Raynaud’s phenomenon.
Sjögren’s (Show grins) syndrome is an autoimmune disorder that has not been directly linked to hepatitis C, but is seen more often in people with hepatitis C than in the general population. The exact cause of Sjögren’s is unknown, but heredity, viral infections and, possibly, hormones may be contributing factors. There also seems to be a link between Sjögren’s and rheumatic disorders such as rheumatoid arthritis. Sjögren’s can affect many parts of the body, but most often affects the tear and saliva glands.
In a review of published studies, it was found that being infected with hepatitis C is significantly associated with having insulin resistance and type 2 diabetes. Therefore, everyone with hepatitis C should have a diabetes test especially if people have additional risk factors. In the general population, “The United States Preventive Services Task (USPSTF) recommends screening for abnormal blood glucose as part of cardiovascular risk assessment in adults aged 40 to 70 years who are overweight or obese. Clinicians should offer or refer patients with abnormal blood glucose to intensive behavioral counseling interventions to promote a healthful diet and physical activity.”
Vitiligo is a specific type of dermatological condition characterized by loss of pigment of the skin that can affect almost any part of the body, including premature graying of hair. The exact cause of vitiligo is unknown but it is believed to be an autoimmune disease that can be caused by genetic and/or environmental factors. The relationship between HCV and vitiligo is controversial. Most studies have not been able to find a direct link between HCV and vitiligo, but some smaller studies have suggested a causal link. Still other studies have found a link between vitiligo and interferon therapy.
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