Prevalence of extra-hepatic manifestations in infection with hepatitis C virus: Study of 140 cases

##plugins.themes.academic_pro.article.main##

A Kahloun
T Babba
B Fathallah
M Ghozzi
H Ezzine
Y Said
M M Azzouz

Abstract

Aim: To determine the extrahepatic manifestations (EHM) in chronic hepatitis C and to correlate signs with age, sex, degree of fibrosis and genotype of hepatitis C virus.
Methods: One hundred forty cases of chronic infection by hepatitis C virus were investigated in a period of 10 years. By interrogation, clinical examination and laboratory tests, the EHM were determined.
Correlations with age, sex, viral genotype and degree of fibrosis were determined by the chi2 test.
Results: Mean age of our patients was 59 years (16-85 years). 74% were women. The genotype 1b was found in 75% of cases. The clinical EHM were found in 62% of cases: buccal dryness in 17.1% of cases, arthralgias in 33% of cases and fatigue in 65% of cases. 25% of patients had at least one biological EHM associated with chronic hepatitis C: proteinuria in 3 cases, cryoglobulinemia in 4 cases, dysthyroidism in 8 cases and more frequently a positive immunologie test. During the follow-up, we found one case of breast cancer, one case of rectal cancer, 2 cases of MALT lymphoma and one case pf splenic lymphoma. A positive correlation was found between the prevalence of EHM in chronic hepatitis C and the female sex. A degree of fibrosis ³ 2 in METAVIR classification was significantly associated with more important frequency of EHM.
Conclusion: EHM should be screened systematically in chronic infection with HCV. Pathogenic mechanisms in a B lymph node proliferation or diabetes and outcome of these abnormalities under antiviral therapy should be further investigated.

Keywords:

Chronic hepatitis, Hepatitis C virus, Extrahepatic manifestations

##plugins.themes.academic_pro.article.details##

References

  1. Ramos M, Jara LJ, Medina F, Rosas J. Systemic autoimmune diseases coexisting with chronic hepatitis C virus infection. J Intern Med 2005; 257: 549-57.
  2. Cacoub P, Poynard T. Extrahepatic manifestations of chronic hepatitis C. Arthritis Rheum 2000; 42: 2204-12.
  3. Sène D, Limal N, Cacoub P. Hepatitis C virus-associated extra hepatic manifestations: a review. Metab Brain Dis 2004; 19: 357-81.
  4. Sène D, Saadoun D, Limal N, Piette JC, Cacoub P. Update in Hepatitis C virus associated extrahepatic manifestations. Rev Med Interne. 2007; 28: 388-93.
  5. Cacoub P, Renou C, Rosenthal E, et al. Extrahepatic manifestations associated with hepatitis C virus infection. A prospective multicenter study of 321 patients. The GERMIVIC. Groupe d'Etude et de Recherche en Medecine Interne et Maladies Infectieuses sur le Virus de l'Hepatite C. Medicine (Baltimore). 2000; 79: 47-56.
  6. Lunel F, Cacoub P. Treatment of autoimmune and extra-hepatic manifestations of HCV infection. Ann. Med. Interne, 2000; 151: 58-64.
  7. Poynard T, Cacoub P, Ratziu V et al. Fatigue in patients with chronic hepatitis C. J Viral Hepat 2002; 9: 295-303.
  8. Daniel M F, Simon D. Central nervous system changes in hepatitis C virus infection. Eur j Gastroenterol Hepatol 2006; 18:333-38.
  9. Cacoub P et al. Mixed cryoglobulinemia and hepatitis C virus. Am J Med 2003; 96: 124-34.
  10. Saadoun D, Asselah T, Resche-Rigon M, et al. Cryoglobulinemia is associated with steatosis and fibrosis in chronic hepatitis C. Hepatology. 2006; 43: 1337-45.
  11. Malaguarnera M, Pia Gargante M, Risino C, et al. Hepatitis C virus in elderly cancer patients. Eur J Intern Med. 2006; 17: 325-9.
  12. Machida K, Cheng KT. Hepatitis C virus induces a mutator phenotype: enhanced mutations of immunoglobulin and protooncogenes. Proc Natl Acad Sci 2004; 101: 4262-7.
  13. Ferri C, La Civita L. Can type C hepatitis infection be complicated by malignant lymphoma? Lancet 1995; 346: 1426-7.
  14. Luppi M, Longo G, Ferrari MG, et al. Clinico-pathological characterization of hepatitis C virus-related B-cell non-Hodgkin's lymphomas without symptomatic cryoglobulinemia. Ann Oncol. 1998 ;9:495-8.
  15. Knobler H, Schihmanter R. Increased risk of type 2 diabetes in non cirrhotic patients with chronic hepatitis C virus infection. Mayo Clin Proc 2000; 75: 355-9.