Extrahepatic Manifestations of Hepatitis C Infection: Navigating CHASM

Abstract

Purpose of review This article describes the importance of extra-hepatic systemic manifestations of chronic hepatitis C virus (HCV) infection. Recent findings While most HCV literature focuses on liver injury and fibrosis progression, a spectrum of systemic disease processes, collectively called CHASM (C Hepatitis Associated Systemic Manifestations) are present in a high proportion of infected persons. These include thyroid disease (Hashimoto’s thyroiditis, Graves disease, thyroid cancer), cardiovascular disease (atherosclerosis, carotid artery disease, coronary artery disease), renal disease (MPGN, glomerulosclerosis), eye disease (Mooren’s ulcers, sicca syndrome), skin disease (PCT, vasculitis, lichen planus), and lymphomas (NHL, splenic T-cell), and diabetes. Summary Mechanistic understanding of how HCV leads to CHASM processes could lead to development of new interventions. The role of early HCV treatment and cure may result in preventive strategies for a variety of complex disease states.

Review article: treatment as prevention – targeting people who inject drugs as a pathway towards hepatitis C eradication

“…HCV‐related liver cirrhosis remains the main indication for liver transplantation in developed countries . Chronic HCV infection is also associated with various extra‐hepatic manifestations …”

Study of Human Leukocyte Antigen (HLA) in 13 cases of familial frontal fibrosing alopecia: CYP21A2 gene p.V281L mutation from congenital adrenal hyperplasia linked to HLA class I haplotype HLA‐A*33:01; B*14:02; C*08:02 as a genetic marker

“…Conserved allelic variants of innate immunity genes located between F16 HLA class I haplotype and CYP21A2 gene p.V281L mutation could also play a role; they may help breaking the immunoprivilege advantage of the follicle by inducing the expression of HLA class I molecules on the cells of the bulge and then promoting local inflammation. Reports relating hepatitis C virus infection and cutaneous and oral lichen planus support this hypothesis . The determination of the presence of oligoclonal expansion of CD8+ T cells with a narrow T cell receptor repertoire in the inflammatory infiltrate of FFA would be another supporting data.…”

O olho na hepatite C: uma revisão

“…The pathogenesis of ocular changes is possibly due to the direct action of the virus and immunological reactions to certain viral antigens and even immune complexes (33)(34)(35) . The same explanation could apply to other HCV-associated extrahepatic manifestations, of which cryoglobulinemia is one of the more frequent manifes-tations, found in up to 50% of HCV carriers and most frequently presents as vasculitis in various organs (33)(34)(35)(36) . The virus could also act as a trigger for autoimmune reactions, causing tissue damage and dysfunction (37) .…”