Extrahepatic manifestations of hepatitis C infection

Infekcija hepatitis C virusom je globalni javnozdravstveni problem, koji zahvaća 70 milijuna ljudi. Hepatotropna i limfotropna priroda virusa uzrokom je nastanka širokog spektra hepatalnih i ekstrahepatalnih manifestacija, zbog čega se kronična hepatitis C infekcija smatra sistemskom bolešću. Čak 40-80% pacijenata razvit će barem jednu ekstrahepatalnu manifestaciju tijekom kronične faze bolesti, štoviše one su ponekad i jedini znak hepatitis C infekcije. Najčešća ekstrahepatalna manifestacija je esencijalna miješana krioglobulinemija. Pojava ove manifestacije može imati ozbiljne posljedice, budući da se promjene mogu odraziti na proliferaciju B-limfocita i rezultirati nastankom B non-Hodgkin limfoma. Češća je ipak posljedica nastanak sistemskog vaskulitisa, uslijed kojeg se može razviti membranoproliferativni glomerulonefritis, koji može imati nepredvidiv tijek i rezultirati nastankom bubrežnog zatajenja. Pacijenti s kroničnom HCV infekcijom također imaju veću učestalost drugih ektrahepatalnih manifestacija uključujući kožne, autoimune bolesti, endokrinološke, kardiovaskularne i neuropsihijatrijske poremećaje, koji osim što pogoršavaju prognozu bolesti, imaju znatan utjecaj i na kvalitetu života pacijenata. Za kliničare je vrlo važno da posumnjaju na ekstrahepatalne manifestacije kod pacijenata s kroničnom HCV infekcijom, jer sama spoznaja o širokom spektru ekstrahepatalnih manifestacija može pomoći ranijoj dijagnozi i pravovremenom liječenju. Ovaj rad nudi sažet prikaz ektrahepatalnih manifestacija HCV infekcije s osvrtom na patogenezu te sistemske i organ specifične promjene.Hepatitis C virus infection is a global public health issue that affects about 70 million people. Because of its hepatotropic and lymphotropic nature, which includes a wide spectrum of hepatic and extrahepatic manifestations, chronic hepatitis C infection is considered a systemic disease. Up to 80% of patients will develop at least one extrahepatic manifestation during the chronic phase of the disease; moreover, these manifestations could be the only symptom of hepatitis C infection. The most common extrahepatic manifestation is essential mixed cryoglobulinemia, whose progress can have a severe outcome as it affects the proliferation of B-lymphocytes which in turn could cause the development of B-cell non-Hodgkin’s lymphoma. More often the effect of mixed cryoglobulinemia is systemic vasculitis, on ground of which membranoproliferative glomerulonephritis may arise with an unpredictable course that can lead to end-stage kidney disease. In addition, patients with chronic HCV infection have a higher frequency of other extrahepatic manifestations including skin disoreders, autoimmune diseases, endocrine and cardiovascular and neuropsychiatric disorders that may worsen their prognosis and have a significant effect on the quality of their life. It is extremely important that clinicians consider the potential of HCV to cause extrahepatic manifestations in patients with chronic HCV infection, because an awareness of the range of potential extrahepatic manifestations could facilitate earlier diagnosis and a more appropriate and timely treatment of these disorders. This paper provides a brief overwiev of HCV-related extrahepatic manifestations with an emphasis on pathogenesis as well as systemic and organ-specific changes