Extrahepatic manifestations of hepatitis C among United States male veterans

Abstract

Hepatitis C virus (HCV) has been associated with several extrahepatic conditions. To date, most studies assessing these associations involved small numbers of patients and lacked a control group. Using the computerized databases of the Department of Veterans Affairs, we carried out a hospital-based case-control study that examined all cases of HCV-infected patients hospitalized during 1992 to 1999 (n = 34,204) and randomly chosen control subjects without HCV (n = 136,816) matched with cases on the year of admission. The inpatient and outpatient files were searched for several disorders involving the skin (porphyria cutanea tarda [PCT], vitiligo, and lichen planus); renal (membranous glomerulonephritis [GN] and membranoproliferative glomerulonephritis); hematologic (cryoglobulin, Hodgkin's and non-Hodgkin's lymphoma [NHL]); endocrine (diabetes, thyroiditis); and rheumatologic (Sjögren's syndrome). The association between HCV and these disorders was examined in multivariate analyses that controlled for age, gender, ethnicity, and period of military service. Patients in the case group were younger in age (45 vs. 57 years), were more frequently nonwhite (39.6% vs. 26.3%), and were more frequently male (98.1% vs. 97.0%). A significantly greater proportion of HCV-infected patients had PCT, vitiligo, lichen planus, and cryoglobulinemia. There was 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 or NHL. However, NHL became significant after age adjustment. Diabetes was more prevalent in controls than cases, but no statistically significant association was found after adjustment for age. In conclusion, we found a significant association between HCV infection and PCT, lichen planus, vitiligo, cryoglobulinemia, membranoproliferative GN, and NHL. Patients presenting with these disorders should be tested for HCV infection.

Extrahepatic replication of HCV: Insights into clinical manifestations and biological consequences

“…26 Over the last decade, epidemiological data have demonstrated a possible link between porphyria cutanea tarda, lichen planus, Sjögren's syndrome and HCV. 27 More recently, HCV has been associated with fatigue 28 and insulin resistance though this association is weak. 29,30 HCV has also been implicated in the pathogenesis of acquired aplastic anemia, although this hematological disorder is uncommon in HCV infected individuals and the available evidence to support a causal relationship is very limited.…”

Response to antiviral treatment in hepatitis C virus-associated marginal zone lymphomas

“…[13][14] The major pitfall in the interpretation of both results was the small size of samples. More recently, one prospective cohort study in Northern California 15 and two case-control studies, one in the USA 16 and one in Italy, 17 tried to address the question in large cohorts of patients. The first found that HCV infection did not precede at significant rates the development of B-cell lymphoproliferative disorders, while the two others did show a significant association between HCV and lymphomas.…”

758 Frequency of Elevated Biomarkers in Patients With Cryptogenic Hepatocellular Carcinoma

“…It is estimated that half a million cases occur worldwide annually, making primary liver cancer the fifth most common malignancy in men and the ninth in women [1][2][3][4][5][6]. Hepatocellular carcinoma (HCC) accounts for 85% to 90% of primary liver cancers [7] and the age-adjusted HCC mortality rate has increased in recent decades in Japan [8].…”