RESEARCH - Extrahepatic manifestations in patients with chronic hepatitis C virus infection

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Curr Opin Rheumatol. 2005 Jul;17(4):447-55.

Extrahepatic manifestations in patients with chronic hepatitis C virus

infection.

Ramos-Casals M, Font J.

Department of Autoimmune Diseases, Institut d'Investigacions Biomediques

August Pi i Sunyer, School of Medicine, University of Barcelona, Hospital

Clinic, Barcelona, Spain.

PURPOSE OF REVIEW: Chronic hepatitis C virus infection often has autoimmune

clinical and analytic features. This review analyzes recent data on the

close association of chronic hepatitis C virus infection with autoimmune and

lymphoproliferative processes. RECENT FINDINGS: Hepatitis C virus infection

has been associated with both organ-specific (thyroiditis, diabetes) and

systemic autoimmune diseases. Experimental, virologic, and clinical evidence

has demonstrated a close association between hepatitis C virus infection and

Sjogren syndrome, with hepatitis C virus-associated Sjogren syndrome being

indistinguishable in most cases from the primary form. With respect to

rheumatoid arthritis, patients with hepatitis C virus-related polyarthritis

and positive rheumatoid factor may fulfill the classification criteria for

rheumatoid arthritis. Hepatitis C virus has also been associated with an

atypical presentation of antiphospholipid syndrome, as well as with the

development of sarcoidosis. A higher prevalence of hematologic processes in

patients with hepatitis C virus infection has recently been reported,

including cytopenias and lymphoproliferative disorders. Recent data are

available on the use of new immunosuppressive and biologic agents (mainly

mycophenolate mofetil, anti-tumor necrosis factor agents, and rituximab) in

patients with hepatitis C virus infection and autoimmune or

lymphoproliferative manifestations.

SUMMARY: There is increasing evidence of

a close association of hepatitis C virus infection with autoimmune and

hematologic processes. The sialotropism of hepatitis C virus may explain the

close association with Sjogren syndrome, and its lymphotropism links the

virus to cryoglobulinemia, autoimmune cytopenias, and lymphoma. The

substantial overlap between cryoglobulinemic features and the classification

criteria for some systemic autoimmune diseases (systemic lupus

erythematosus, rheumatoid arthritis, and polyarteritis nodosa) make the

differentiation between mimicking and coexistence difficult.

PMID: 15956842

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ct & list_uids=15956842

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