What diseases are associated with Hepatitis C (HCV)?

Diseases Associated with Hepatitis C

Hepatitis C virus (HCV) infection is associated with numerous hepatic and extrahepatic diseases, including chronic liver disease, cirrhosis, hepatocellular carcinoma, and various immunological disorders such as cryoglobulinemia, lymphoma, and cardiovascular diseases. 1

Hepatic Manifestations

Liver Disease Progression

• Acute hepatitis: Occurs in the first 6 months after exposure, asymptomatic in 75% of cases. When symptoms occur, they include abdominal pain, nausea, anorexia, jaundice, and malaise 1
• Chronic hepatitis: Develops in 55-85% of infected individuals who don't clear the virus within 6 months 1
• Cirrhosis: Without treatment, 15-30% of patients with chronic HCV develop cirrhosis within 20 years 1
• Hepatocellular carcinoma (HCC):
  • 27% of those with cirrhosis develop HCC within 10 years without treatment 1
  • In southern Europe and Japan, 50-75% of HCCs are associated with HCV 1
  • Development rates in patients with established cirrhosis range between 1-7% per year 1

Risk Factors for Disease Progression

• Alcohol consumption accelerates fibrosis progression 1
• HBV coinfection increases risk of HCC development 1
• Daily consumption of >50g alcohol is associated with increased rate of fibrosis progression 1

Extrahepatic Manifestations

HCV infection is associated with numerous extrahepatic manifestations, affecting multiple organ systems:

Immunological Disorders

• Essential mixed cryoglobulinemia: High degree of association with HCV 1, 2
• Autoimmune hepatitis 1
• Sjögren's syndrome 1
• Lichen planus 1
• Thyroiditis 1
• Membranous glomerulonephritis 1
• Polyarteritis nodosa 1
• Idiopathic thrombocytopenic purpura 1, 3

Metabolic Disorders

• Insulin resistance 1
• Type 2 diabetes mellitus 1

Hematologic Disorders

• Thrombocytopenia: Common in advanced HCV infection, often correlates with severity of liver disease and portal hypertension 3
• Lymphoma: Particularly splenic lymphoma 2

Cardiovascular Diseases

• Clear causal relationship between chronic HCV infection and cardiovascular diseases 1

Dermatologic Disorders

• Porphyria cutanea tarda 2

Impact on Pregnancy and Neonatal Outcomes

HCV infection during pregnancy is associated with:

• Small-for-gestational-age infants 1
• Low birthweight (<2500g) 1
• Increased need for NICU admission 1
• Increased need for assisted ventilation 1
• Vertical transmission (mother-to-child) 1

Clinical Implications and Management Considerations

Disease Monitoring

• Low platelet count (<75,000/μL) often correlates with advanced fibrosis in HCV patients 3
• Regular assessment of liver function and fibrosis stage is essential 3
• For patients with cirrhosis, monitoring for HCC is recommended (rates of 1-7% per year) 1

Treatment Considerations

• Direct-acting antivirals (DAAs) can improve both hepatic and extrahepatic manifestations 3
• Among patients with cirrhosis treated with antivirals who achieve sustained virologic response, only 5% develop HCC within 10 years (compared to 27% without treatment) 1
• Special attention needed for patients with thrombocytopenia, especially when considering interferon-based treatments 3

Common Pitfalls

• Attributing all thrombocytopenia to portal hypertension without considering immune-mediated mechanisms 3
• Overlooking HCV as a cause of immune thrombocytopenia 3
• Failing to monitor for thrombotic complications when using thrombopoietin receptor agonists 3

Understanding the wide range of diseases associated with HCV is crucial for comprehensive patient management and improving outcomes through early detection and appropriate treatment of both hepatic and extrahepatic manifestations.