Hepatitis C virus (HCV) infection is most commonly associated with progressive liver disease. As a result, the focus of many patients and clinicians is sometimes limited to that problem. HCV may be, however, associated with a number of extrahepatic conditions, and these conditions may cause significant morbidity and mortality in patients with chronic HCV.

These conditions remain, however, somewhat poorly defined due to most of the studies evaluating the association of these conditions with HCV involving small numbers of patients and lacking a control group

In a study recently published in Hepatology, investigators used the computerized databases of the Department of Veterans Affairs to perform a hospital-based case-control study. The study reviewed all 34,204 cases of HCV-infected patients hospitalized during 1992 to 1999 and a randomly chosen group of 136,816 control subjects without HCV matched with cases on the year of admission.

These records were searched for several disorders commonly thought to be associated with HCV, including porphyria cutanea tarda [PCT], vitiligo, lichen planus, membranous glomerulonephritis [GN], membranoproliferative glomerulonephritis, cryoglobulin, Hodgkin's and non-Hodgkin's lymphoma [NHL], diabetes, thyroiditis and Sjögren's syndrome.

Using a multivariate analyses that controlled for age, gender, ethnicity, and period of military service, the investigators found that a significantly greater proportion of HCV-infected patients had PCT, vitiligo, lichen planus, and cryoglobulinemia.

There was also a greater prevalence of membranoproliferative GN among patients with HCV, but not membranous GN. There was no significant difference in the prevalence of thyroiditis, Sjögren's syndrome, or Hodgkin's lymphoma. After adjustment for age, NHL was significantly associated with HCV, while diabetes was not.

The authors conclude, "we found a significant association between HCV infection and PCT, lichen planus, vitiligo, cryoglobulinemia, membranoproliferative GN, and NHL…First, we suggest that health care providers should screen for HCV in patients with these diseases. Second, this study highlights the need for a multidisciplinary approach to the management of HCV in the VA. Future studies are warranted to assess the impact of these disorders on the clinical course of HCV and the effect, if any, of antiviral therapy."

12/06/02

Reference
H El-Serag and others. Extrahepatic manifestations of hepatitis C among United States male veterans. Hepatology 2002; 3 6:1439-1445.