Viral Hepatitis
Copyright ©2007 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Dec 28, 2007; 13(48): 6518-6528
Published online Dec 28, 2007. doi: 10.3748/wjg.v13.i48.6518
Chronic hepatitis C virus infection: Prevalence of extrahepatic manifestations and association with cryoglobulinemia in Bulgarian patients
Diana V Stefanova-Petrova, Anelia H Tzvetanska, Elisaveta J Naumova, Anastasia P Mihailova, Evgenii A Hadjiev, Rumiana P Dikova, Mircho I Vukov, Konstantin G Tchernev
Diana V Stefanova-Petrova, Konstantin G Tchernev, Department of Internal Diseases and Gastroenterology, University Hospital Alexandrovska, Sofia 1431, Bulgaria
Anelia H Tzvetanska, Viral Laboratory, University Pediatric Hospital, Sofia 1431, Bulgaria
Elisaveta J Naumova, Anastasia P Mihailova, Central Laboratory of Immunology, University Hospital Alexandrovska, Sofia 1431, Bulgaria
Evgenii A Hadjiev, Department of Hematology, University Hospital Alexandrovska, Sofia 1431, Bulgaria
Rumiana P Dikova, Department of Pathology, University Hospital Alexandrovka, Sofia 1431, Bulgaria
Mircho I Vukov, National Centre for Health Information, Sofia 1431, Bulgaria
Correspondence to: Dr. Diana V Stefanova-Petrova, Depart-ment of Internal Diseases and Gastroenterology, University Hospital Alexandrovska, 1, Georgi Sofiiski Str, Sofia 1431, Bulgaria. d.petrova.stefanova@gmail.com
Telephone: +359-2-9478670 Fax: +359-2-9230654
Received: August 26, 2007
Revised: September 28, 2007
Accepted: October 6, 2007
Published online: December 28, 2007
Abstract

AIM: To assess the prevalence of extrahepatic manifestations in Bulgarian patients with chronic hepatitis C virus (HCV) infection and identify the clinical and biological manifestations associated with cryoglobulinemia.

METHODS: The medical records of 136 chronically infected HCV patients were reviewed to assess the prevalence of extrahepatic manifestations. Association between cryoglobulin-positivity and other manifestations were identified using χ2 and Fisher’s exact test. Risk factors for the presence of extrahepatic manifestations were assessed by logistic regression analysis.

RESULTS: Seventy six percent (104/136) of the patients had at least one extrahepatic manifestation. Clinical manifestations included fatigue (59.6%), kidney impairment (25.0%), type 2 diabetes (22.8%), paresthesia (19.9%), arthralgia (18.4%), palpable purpura (17.6%), lymphadenopathy (16.2%), pulmonary fibrosis (15.4%), thyroid dysfunction (14.7%), Raynaud’s phenomenon (11.8%), B-cell lymphoma (8.8%), sicca syndrome (6.6%), and lichen planus (5.9%). The biological manifestations included cryoglobulin production (37.5%), thrombocytopenia (31.6%), and autoantibodies: anti-nuclear (18.4%), anti-smooth muscle (16.9%), anti-neutrophil cytoplasm (13.2%) and anti-cardiolipin (8.8%). All extrahepatic manifestations showed an association with cryoglobulin-positivity, with the exception of thyroid dysfunction, sicca syndrome, and lichen planus. Risks factors for the presence of extrahepatic manifestations (univariate analysis) were: age ≥ 60 years, female gender, virus transmission by blood transfusions, longstanding infection (≥ 20 years), and extensive liver fibrosis. The most significant risks factors (multivariate analysis) were longstanding infection and extensive liver fibrosis.

CONCLUSION: We observed a high prevalence of extrahepatic manifestations in patients with chronic HCV infection. Most of these manifestations were associated with impaired lymphoproliferation and cryoglobulin production. Longstanding infection and extensive liver fibrosis were significant risk factors for the presence of extrahepatic manifestations in HCV patients.

Keywords: Hepatitis C; Liver cirrhosis; Extrahepatic manifestations