Chronic extrahepatic manifestation

Extrahepatic disease manifestations associated with chronic hepatitis B and C are frequent about 40 forms, mainly autoimmune disorders, have been reported up to now. (s. tabs. 22.2, 22.7, 22.8, 32.3, 32.6, 33.2) A reliable association of these manifestations with HBV and HCV is not known, nor is a true frequency given. The most common association is found with HCV infection. Apparently, HCV has tropism for cells other than hepa-tocytes, particularly lymphocytes. Therefore it has been postulated that the HCV infection of lymphocytes may be the cause of a greater number of extrahepatic (especially autoimmune) diseases. A selection of extrahepatic manifestations shows the wide clinical spectrum of these disorders. (67, 112, 119) (s. tab. 34.6)... 

The indication for antiviral treatment of chronic hepatitis C is principally based on the following criteria (1.) a symptomatic course (subjective complaints, elevated transaminases, extrahepatic manifestations), (2.) inflammatory activity and progressive fibrosis or cirrhosis, and (i.) an infection risk regarding contact persons. 

Chronic HCV infection is associated with evidence of chronic liver injury in most cases. Elevations in liver-associated enzymes, particularly ALT, are usually mild and fluctuate between normal and abnormal in most infected individuals. In an estimated 15% to 20% of cases, cirrhosis becomes evident an average of 20 to 30 years after exposure. HCC may develop once cirrhosis is present at an average rate of 1.5 to 3 cases per year. In North America, Europe, and Japan, HCV is the most common risk factor in development of HCC. There are a number of extrahepatic manifestations of chronic HCV infection the most common are cryoglobulinemia and porphyria cutanea tarda. There is epidemiological evidence linking HCV to increased risk of lymphoma and type 2 diabetes meUitus. 

HCV has been associated with many extrahepatic manifestations [35, 36, 67], including myocarditis and cardiomyopathy [68, 69]. Histological and functional observations have led to the hypothesis that mast cells play an important role in many fibrotic reactions [70-72], Potential mast cell-derived mediators of the fibrotic response include histamine, tryptase and TGF-fl, which stimulate fibroblast proliferation and collagen synthesis [73-75]. By producing these factors, chronic activation of cardiac mast cells by protein Fv may contribute to the heart fibrosis found in some patients with HCV infection [68, 69]. 

Willson RA Extrahepatic manifestations of chronic viral hepatitis. Am J Gastroenterol 1997 92 3-17. 

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