Chapter 20

Extrahepatic Manifestations of Hepatitis C Virus Infection

Benjamin Maasoumy

Benjamin Maasoumy

Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany

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Michael P. Manns

Michael P. Manns

Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany

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Markus Cornberg

Markus Cornberg

Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany

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First published: 26 July 2013
Citations: 1

Summary

Hepatitis C virus (HCV) can replicate outside the liver and therefore cause extrahepatic manifestations. Patients can present with rheumatological, neurological, nephrological, or dermatological symptoms. Extrahepatic manifestations are classified according to their prevalence in HCV-infected patients and their pathogenic link to HCV. Lymphoproliferative disorders such as mixed cryoglobulinemia represent the most closely related extrahepatic manifestations of HCV. For several extrahepatic manifestations, especially those with a pathogenic link, elimination of HCV is associated with clinical improvement. Therefore, antiviral therapy is considered as the first treatment option; however, achievement of sustained virological response may not always result in clinical response, and antiviral therapy may lead to an exacerbation of extrahepatic symptoms. Different extrahepatic manifestations require different alternative therapeutic strategies, for example treatment with rituximab in patients with severe mixed cryoglobulinemia syndrome. The management of HCV-associated extrahepatic manifestations is complex and necessitates a team of experts in different medical specialties.

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