Complications of Hepatitis C

Chronic hepatitis C (HCV) involves a range of complications affecting the liver and other organs throughout the body. After exposure to HCV, about 80% of people develop chronic infection and 60% to 70% of these people will develop chronic liver disease. About 20% to 30% of people with chronic HCV will develop cirrhosis over a 20- to 30-year period.1

Because the liver plays such a pivotal role in the health of the body, when HCV impairs liver function, there can be a range of complications outside of the liver. 1 In one study, 38% of subjects with chronic HCV infection had at least one complication outside the liver. Skin (dermatologic) complications were common, affecting 17% of people and musculoskeletal complications (joint and muscle pain) occurred in 19% of people. 2

HCV complications outside of the liver

Overall 38%
  • Skin (at least one complication)
  • Purpura
  • Raynaud phenomenon
  • Cutaneous vasculitis
  • Pruritis
  • Psoriasis
Rheumatologic involvement
  • Arthralgia
  • Arthritis
  • Myalgia
  • Sicca syndrome (mouth)
  • Sicca syndrome (eye)
  • Hypertension

Adapted from Chopra S. Clinical manifestations and natural history of chronic hepatitis C virus infection. Uptodate. Di Bisceglie AM, Bloom A, eds. Accessed at: 2014.

The major extra hepatic (this means outside the liver) complications associated with HCV include3:

    • Hematologic disorders
    • Autoimmune disorders
    • Dermatologic disorders
    • Diabetes mellitus
    • Eye disease
    • Kidney disease
    • Musculoskeletal disorders

HCV complications outside of the liver

Hematologic disorders
Cryoglobulinemia Monoclonal gammopathy
Autoimmune disorders
Sjögren’s syndrome Thyroid disease
Lupus Rheumatoid arthritis
Dermatologic disorders
Raynaud phenomenon Purpura
Cutaneous vasculitis Porphyria cutanea tarda
Psoriasis Pruritis
Diabetes mellitus
Eye disease
Corneal ulcer Sicca syndrome
Uveitis Dry eye
Kidney disease
Glomerular disease
Musculoskeletal disorders
Arthritis Decreased bone mineral density
Myalgia Arthralgia

Hematologic disorders

Several hematologic (blood) disorders are associated with HCV infection. One is cryoglobulinemia, in which the blood contains abnormal proteins called cryoglobulins. These proteins can thicken and clump together in blood vessels. Cryoglobulinemia can affect skin, muscles, joints, nerves, liver and kidneys. Joint pain, kidney disease, nerve problems, and purport (purplish skin discoloration) are common signs and symptoms of cryoglobulinemia.3

HCV infection is also associated with conditions called monoclonal gammopathies, where there is an abnormal increase in B lymphocytes (a type of white blood cell) resulting in abnormally high amounts of immunoglobulin (antibody) production. HCV infection can also result in development of several different types of lymphomas, cancers of the lymph system.

Autoimmune disorders

HCV infection is associated with increased production of autoantibodies, antibodies that the body produces against its own tissues. A number of autoimmune disorders are associated with HCV infection, including3:

  • Thyroid disease. Thyroid disease (most commonly hypothyroidism) occurs in 2% to 13% of people with HCV. The thyroid produces hormones that regulate metabolism and growth. Over time, hypothyroidism can lead to problems, including obesity, joint pain, infertility and heart disease.
  • Sialadenitis. Sialadenitis is an autoimmune condition that affects the salivary gland, causing inflammation, pain, and swelling, as well as decreased production of saliva.
  • Autoimmune thrombocytopenic purpura (ATP). ATP is a condition marked by low platelet count with normal bone marrow and the absence of other causes of thrombocytopenia (low platelet count). Since platelets are important in blood clotting, purple spots (purpura) appear on the skin caused by internal bleeding from small blood vessels.
  • Sjögren’s syndrome. Sjögren’s syndrome is a chronic autoimmune disease in which the immune system attacks moisture-producing glands. This condition is often found in people with rheumatoid arthritis and systemic lupus erythematosus.
  • Rheumatoid arthritis (RA). RA is an autoimmune disease in which an immune response is launched against joints and related structures.
  • Systemic lupus erythematosus (SLE). SLE is an autoimmune disease in which the immune system attacks healthy tissue, affecting the skin, joints, kidneys, brain, and other organs.

Dermatologic conditions HCV is associated with a variety of dermatologic diseases and conditions, some of them related to other disorders. Skin conditions common in people with HCV infection include3:

  • Purpura.Purpura refers to purple spots on the skin caused by internal bleeding from small blood vessels.
  • Raynaud phenomenon. Raynaud phenomenon involves severe reduction in blood flow in response to cold or emotional stress. This results in discoloration typically in the fingers and toes.
  • Pruritis. Pruritis is a condition marked by severe itching of the skin.
  • Psoriasis. Psoriasis an autoimmune disorder marked by red, itchy, scaly patches of skin.
  • Cutaneous vasculitis. Cutaneous vasculitis (vasculitis is inflammation of the blood vessels) is a condition that accompanies disease that involve systemic inflammation, such as SLE. Cutaneous vasculitis involves rash with hives, purport, ulcers, and nodules.

Diabetes mellitus

Several studies have shown that risk for development of diabetes is increased in people with HCV. In fact, one analysis found that risk for diabetes was increased by almost 70% in people with HCV. If you have HCV infection, factors such as obesity, a family history of diabetes, and increased age, appear to increase the chances of developing diabetes.3

Ocular disease

HCV is associated with a variety of disorders affecting the eyes, including dry eye, ulcers forming on the cornea, uveitis (inflammation of the uvea or pigmented layer of the eye), and Sicca syndrome. Sicca syndrome is an autoimmune disorder related to Sjögren’s syndrome. It is characterized by dry eyes, dry mouth, and often occurs with a disease of connective tissue, such as RA.3

Kidney disease

HCV infection increases risk of glomerular disease, in which the glomeruli, the structure within the kidney that filters waste products out of the blood, are destroyed. Glomerular disease decreases the ability of the kidneys to maintain a balance of certain substances in bloodstream.3

Musculoskeletal disorders

HCV infection is associated with several musculoskeletal conditions, including loss of bone mineral density, arthritis, and joint pain (arthralgia) and muscle pain (myalgia).3

Written by: Jonathan Simmons | Last reviewed: March 2015.
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