People with chronic hepatitis C aren’t just at risk for liver problems like cirrhosis. Forty to 70 percent may also have “extrahepatic” conditions — ones that occur outside the liver — like kidney disease and diabetes, according to Hepatitis C Online, a web resource produced by clinicians at the University of Washington and the University of Alabama-Birmingham. “There are different reasons why people with hepatitis C also get [other] diseases,” says Kenneth E. Sherman, MD, PhD, a professor of digestive diseases at the University of Cincinnati College of Medicine and coauthor of a key paper about extrahepatic conditions that was published in the September 2015 issue of the journal Current HIV/AIDS Reports. “Either they arise as a direct result of the hepatitis C infection, targeting the organs outside of the liver, or there are immune responses associated with the virus that lead to these conditions.” The good news is, “In general, it seems that curing hepatitis C, which is more possible now, can also cure these other conditions,” says Dr. Sherman. Sherman and his team have been credited with developing an acronym to describe the collection of diseases that has been linked with chronic hepatitis C: CHASM, which stands for C Hepatitis Associated Systemic Manifestations. Here are seven of the most common hepatitis C–related conditions.
1. Diabetes
People with active hepatitis C are nearly twice as likely to have type 2 diabetes as those who haven’t contracted the virus, according to Hepatitis C Online. Although the reasons are not fully understood, Sherman says, hepatitis C “has been associated with the development of insulin resistance within the liver,” which is important, given that the liver plays a key role in the body’s digestive process. The United Kingdom’s Hepatitis C Trust tells people with hepatitis C to eat small meals more frequently to help keep their blood sugar levels stable.
2. Non-Hodgkin’s lymphoma
According to a study published in December 2019 in the Journal of Medical Virology, people with hepatitis C were more than three times as likely to develop non-Hodgkin’s lymphoma — a cancer that starts in the white blood cells — as those without the virus. This may be because most of these cancers start in the B cells, which produce the antibodies the body uses to fight off infections, such as hepatitis C. Notably, treating hepatitis C can result in complete or partial remission of non-Hodgkin’s lymphoma, says Sherman. If you’ve been diagnosed with one of these conditions, he recommends asking your healthcare team to check for the other.
3. Cryoglobulinemia
This condition, which causes reduced blood flow to the fingers and toes, may actually be an indication of Raynaud’s disease. The condition has been linked with active hepatitis C, although the exact relationship between the two remains unclear. “Reduced circulation in cold temperatures results in a painful reduction in blood supply to fingers and toes,” explains Hashem B. El-Serag, MD, MPH, a gastroenterologist and professor and chair of the Margaret M. and Albert B. Alkek Department of Medicine at Baylor College of Medicine in Houston. “Other complications of cryoglobulinemia are joint pain and peripheral neuropathy.” According to Dr. El-Serag, treating and curing the underlying hepatitis C virus can alleviate cryoglobulinemia. If you’ve stopped taking your medications for any reason (even if your doctor has declared you cured), the appearance of cryoglobulinemia symptoms could be a sign the virus has returned or may not have been fully resolved, he says.
4. Skin problems
According to Sherman, dermatologic conditions such as porphyria cutanea tarda (PCT) may occur in as many as 5 percent of people with chronic hepatitis C. PCT, which has been linked to excess iron in the blood, appears as blistering on the hands, forearms, and face and may be the result of liver damage from alcohol use, which increases the risk of hepatitis C. Avoiding alcohol, which everyone with hepatitis C should do, and sunlight exposure can help alleviate the symptoms. “Using sunscreens, testing for a genetic cause of excess iron, and, if needed, [getting a blood test for diagnosis and then] treatment of hepatitis C are key in managing PCT,” El-Serag says. Lichen planus, a chronic autoimmune disease that’s also linked to hepatitis C, is characterized by lesions on the fingernails, toenails, face, scalp, and genitalia. It doesn’t have a proven treatment at present, but your doctor can prescribe medications to alleviate itching and inflammation around the lesions.
5. Kidney disease
Kidney disease can be caused by hepatitis C, according to the National Kidney Foundation. (Conversely, Hepatitis C Online notes that people on dialysis treatment for kidney disease are known to be at increased risk for hepatitis C.) A study published in December 2017 in the journal Annals of Hepatology, which found that risk for chronic kidney disease is nearly 1.5 times higher in those with hepatitis C than in those without the virus, suggests that the insulin resistance caused by the virus may be responsible for the kidney damage.
6. Heart disease
Several studies have suggested a link between hepatitis C and an increased risk for cardiovascular disease, Sherman notes. A review of existing research published in November 2019 in the journal Clinical Cardiology found that people with the virus have elevated levels of several biomarkers — measurable levels of certain chemicals found in the body — used to assess a person’s risk for heart disease, which may explain any relationship that exists between the two conditions. The good news: A review of studies published in May 2019 in the Journal of Hospital Practice found that curing hepatitis C reduces the risk of heart disease in those with the virus.
7. Depression
Hepatitis C has been associated with neuropsychiatric conditions, including depression and “brain fog,” Sherman says. According to a review published in August 2017 in the journal Clinics in Liver Disease, an estimated one-third of people with hepatitis C also have depression, which may stem from the stress of living with the condition or the social stigma surrounding it. And fatigue — both mental and physical — is a common symptom of the virus. The 2017 study found that people with both hepatitis C and depression often report poorer quality of life and higher healthcare costs. Still, successful treatment of hepatitis C leads to improvement in depression in many cases, studies have found. In general, because chronic hepatitis C can now be effectively treated, the virus’s relationship with these and other CHASM conditions doesn’t necessarily make them life threatening, says Sherman. Given the risks, though, it’s important to work with your doctor to monitor your overall health and keep an eye out for them. “We’re now seeing that there is a whole spectrum of diseases … associated with hepatitis C,” Sherman says. “Unfortunately, specialists managing these other diseases aren’t always thinking about hepatitis C, and some of them could be better treated simply by identifying and addressing hepatitis C.”
