Extrahepatic manifestations of chronic hepatitis C virus infection

During hepatitis virus (HCV) chronic infection, extrahepatic manifestations are frequent and polymorphous. Initial description reported in large cohort of patients HCV-related autoimmune and/or lymphoproliferative disorders, from mixed cryoglobulinemia vasculitis to frank lymphomas. The relationship between HCV infection and such immune-related diseases has been formally demonstrated by epidemiological, clinical, immunological, pathological data and results of therapeutic trials. More recently, other non-liver related HCV-disorders have been reported including cardiovascular (i.e. stroke, ischemic heart disease), renal, metabolic, and central nervous system diseases. For these manifestations, most evidence come from large epidemiological studies; there is a need for mechanistic studies and therapeutic trials for confirmation. Beyond the risk of developing liver complications i.e. cirrhosis and liver cancer, HCV infected patients have an increased risk of morbidity and mortality related to non-liver diseases. HCV chronic infection should be analyzed as a systemic disease where extrahepatic consequences increase the weight of its pathological burden. The need of effective viral eradication measures is underlined.