Chronic hepatitis C infection causes problems for parts of the body beyond the
liver. The organs most often affected include the blood vessels, skin,
joints, kidneys, thyroid gland, heart and brain. The virus itself has
been found in the heart, muscles, nerves and lymphatic system. Many
problems may arise from the cirrhosis, per se. Potential problems from
cirrhosis include fluid accumulation in the abdomen, bleeding into the
stomach, jaundice, confusion, poor blood clotting, coma, and
susceptibility to infection.
During the last years many autoimmune manifestations have been correlated with
HCV infection; namely, sicca syndrome, chronic polyarthritis,
polydermatomyositis, fibromyalgia, autoimmune thyroiditis, lung fibrosis,
and diabetes mellitus. (Curr Opin Rheumatol 2000 Jan;12(1):53-60)
Hepatitis has so many symptoms that it’s easy to ascribe all new anomalies to this disease. But HCV patients are not exempt from getting other illnesses also, therefore it is important to regularly monitor your health and to consult with your doctor about the changes as they progress.
Hep C Illness - Outside the Liver
By Paul Harvey
In considering the possible impact of hepatitis C on our health, we should
first question our definition of good health. Some clinicians suggest
that good health is not so much a specific state such as "absence of
disease or illness". They believe that good health is an overall
approach: one that accommodates a certain level of illness as normal and
has people working positively towards overcoming the physical and
emotional problems caused by disease (Lorig et al.). This is quite a
useful approach when considering that most people will develop some type
of chronic illness in their life.
Our complex biological system
An additional issue before examining the possible impact of hepatitis C on
health is consideration of the incredibly complex biological nature of
our bodies. Modern technologies are forever changing our world but they
remain crude in comparison to the fantastic interaction of electrical,
chemical and biological processes that exist within us. Given this level
of complex interactions, it is not unusual that a disease most noticeably
causing illness in one major organ or body system will have some level of
impact on other parts of the body.
Non-liver HCV illness
Studies suggest that hepatitis C related fatigue is not primarily related to
actual liver disease but is linked either to disorders of the immune
system (Eur J Gastro Hept 1999 Aug;11(8):833-8) and (Am J Gastro 1999
May;94(5):1355-60), or to altered neurotransmission (brain tissue)
function (Lancet 1999 Jul 31;354(9176:397).
The most commonly reported symptom of hepatitis C is fatigue. Clinicians are
yet to confirm if this is an extrahepatic condition (an illness affecting
parts of the body other than in the liver), or if it is related to actual
liver damage (see p16). Aside from fatigue and possible complications of
actual liver damage, hepatitis C infection has comparatively little
impact on the rest of our body - although several conditions have been
observed. Of the range of other health conditions linked to hepatitis C,
some have been observed and well documented by clinicians (see below),
while the occurrence of many others have been noted in only a small
number of cases and may yet be explained as simple coincidence.
The publication Hepatitis C: a management guide for general practitioners (Aust
Family Physician 1999;28 SI:27-31) recently listed a range of HCV
extrahepatic conditions (below). Many of these are reported in The Hep C
Review, ED30, September 2000, by Dr Bryan Speed (page 12), Dr Tony Jones
(page 16), Doug Mellors (page 29), Dr Ed Gane (page 30) and Tina Pirola
(page 34).
Arthralgia
Cyroglobulinaemia
Diabetes melitis
Glomerulonephritis
Lichen planus
Non-Hodgkin's lymphoma
Peripheral neuropathy
Porphyria cutanea tarda
Sicca syndrome
Sjogren's syndrome
Thrombocytopaenia
Thyroid disorders
Vasculitis
Summary
The majority of all people in our culture experience chronic illness at some
point in their life. So although it's great to have good health, it's
probably unreasonable to expect to have perfect health. In a small number
of cases, hepatitis C can cause imbalance and illness in various parts of
the body - other than the liver. Given the complexity of our bodies, the
fact that such extra hepatic HCV conditions can occur should not be seen
as abnormal. These "extra hepatic conditions" are not necessarily serious
and properly diagnosed and treated, they should not cause alarm if they
occur. Certainly, they do not warrant unnecessary anxiety.
If anyone suspects they may be experiencing extra hepatic conditions, they
should consult their GP and if necessary, ask for referral to a
hepatologist or other hepatitis specialist. Prior to such consultation,
people should do a "work up" with their doctor; ie. noting the frequency
of possible symptoms and having any relevant blood tests done.
* Paul Harvey is Special Projects Officer with the Hepatitis C Council of NSW, Australia.
Source: The Hep C Review, Ed30, September 2000
