REVIEW – September 2021

Hepatitis C extrahepatic manifestations

Authors: Karl Jõeste, Kadri Kõivumägi, Matti Maimets

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Chronic hepatitis C infection has been associated with pathological manifestations in many other tissues apart from the liver. This review aims to summarize possible common extrahepatic manifestations (EMs) based on contemporary literature. Cryoglobulinaemia, lymphoproliferative diseases, renal impairment, cardiovascular and metabolic effects, which are thoroughly discussed in this review, are just few of acknowledged EMs. Although many EMs are difficult to link directly with HCV infection, numerous epidemiological studies confirm these associations. Not long ago it has become evident that HCV is a cause of multitude of autoimmune alterations, which further confirm the connection. The most apparent link is supported by disappearance of most EMs after successful HCV treatment eradicating the virus. As in about two thirds of chronically infected patients develops some sort of autoimmune reaction, early diagnosis of HCV and provision of adequate treatment are crucial. Recent developments in HCV treatment, introducing direct-acting antivirals, which are nearly 100% effective and result in far less side-effects than their predecessors, open a new window in management of EMs. When applied to all patients with HCV, regardless of liver fibrosis, all of the above manifestations could be prevented.