Extrahepatic manifestations of chronic hepatitis C

Objective To assess the prevalence of clinical and biologic extrahepatic ma nifestations of hepatitis C virus (HCV) infection and to identify associati ons between clinical and biologic manifestations. Methods. To analyze the natural history of extrahepatic manifestations of H CV infection, we reviewed only the data recorded prospectively during the f irst visit of 1,614 patients with chronic HCV infection, coming from a sing le monocenter cohort. Exclusion criteria were positivity fur hepatitis B su rface antigen or human immunodeficiency virus. The prevalence of dermatolog ic, rheumatologic, neurologic, and nephrologic manifestations; diabetes; ar terial hypertension; autoantibodies; and cryoglobulins were assessed. Them, using multivariate analysis, we Identified demographic, biochemical, immun ologic, virologic, and liver histologic factors associated with the presenc e of extrahepatic manifestations. Results, At least 1 clinical extrahepatic manifestation was observed in eac h of 1,202 patients (74%). Five manifestations had a prevalence >10%: arthr algia (23%), paresthesia (17%), myalgia (15%), pruritus (15%), and sicca sy ndrome (11%), Four biologic abnormalities had a prevalence >5%: cryoglobuli ns (40%), antinuclear antibodies (10%), low thyroxine level (10%), and anti -smooth muscle antibodies (7%), Only vasculitis, arterial hypertension, pur pura, Lichen planus, arthralgia, and low thyroxine level were associated wi th cryoglobulin positivity. By univariate and multivariate analyses, the mo st frequent risk factors for the presence of clinical and biologic extrahep atic manifestations were age, female sex, and extensive liver fibrosis, Conclusion. Extrahepatic clinical manifestations are frequently observed in HCV patients and involve primarily the joints, muscles, and skin, The most frequent immunologic abnormalities include mixed cryoglobulins, antinuclea r antibodies, and anti-smooth muscle antibodies, The most frequent risk fac tors for the presence of clinical and biologic extrahepatic manifestations are advanced age, female sex, and extensive liver fibrosis.