Chronic hepatitis C damages more than the liver. It drives immune-complex and lymphoproliferative disease, it is associated with skin and metabolic disorders, and it is one of the leading causes of hepatocellular carcinoma.
Immune-complex and lymphoproliferative disease
Essential mixed cryoglobulinemia (EMC) is an immune-complex disorder in which antibody complexes deposit in small blood vessels; it belongs to the B-cell lymphoproliferative disorders and can, in rare cases, progress to B-cell lymphoma. One important laboratory sign of HCV infection is a precipitate of IgM that forms at cooler temperatures, called HCV-associated cryoglobulin — the phenomenon that gives cryoglobulinemia its name.
Skin and metabolic associations
HCV has been associated with the skin disorders lichen planus and porphyria cutanea tarda; the relation between HCV and these dermatological disorders is not yet established. Metabolic disorders arise because the virus relies on lipoprotein assembly and production for its life cycle, and the metabolic complications of HCV infection include hepatic steatosis and hypercholesterolemia.
Hepatocellular carcinoma
Chronic infection with hepatitis B virus (HBV) and HCV together is the major risk factor for hepatocellular carcinoma (HCC), accounting for around 80% of cases worldwide. Among people with HCV-related cirrhosis, the annual risk of HCC is about 1-4%, and more than 50% of HCC arising in chronic hepatitis is attributed to HCV infection.
Other extra-hepatic associations
Chronic HCV has also been linked to a wider group of extra-hepatic disorders:
- cardiovascular disorders
- cerebrovascular disorders
- non-liver malignancies
- renal diseases
- cognitive disorders
- rheumatological disorders