Extrahepatic manifestations of chronic hepatitis C and their influence on response to treatment with Pegylated interferon alfa-2a and ribavirin

Abstract

Thirty to 50% of patients with chronic hepatitis C (CHC) have one or more extrahepatic manifestations (EHMs) of hepatitis C virus (HCV) infection. The aim of this study was to evaluate the frequency of EHMs and to investigate the efficacy of pegylated interferon (Peg-IFN)-alpha-2a plus ribavirin therapy in patients with HCV-related EHMs. The study included 280 patients suffering from CHC and treated with Peg-IFN-alpha-2a and ribavirin.The patients were divided in two groups according to presence or absence of EHMs. We evaluated virological response to antiviral therapy. One or more EHMs were found among 27.9% of patients. Most frequently they had rheumatoid factor in serum (12.5%), organ-nonspecific antibodies ANA and AGMA (12.4%), thyroid hormone disorders (9.3%), vasculitis (5.7%), diabetes mellitus (4.65%), glomerulonephritis (0.71%), and porphyria cutanea tarda (0.36%). Among the patients with EHMs there was 52.6% of females vs. 30.2% of females in the group of patients without EHMs (p=0.001). HCV genotypes 1 and 4 had 85.9% patients with EHMs vs. 58.4% of patients without EHMs (p=0.000). Progressive fibrosis and cirrhosis were more frequently recorded in the EHM group of patients (32% vs. 23.2%), but without statistically significant difference (p=0.532). Serious adverse events of Peg-IFN-alpha-2a and ribavirin were statistically significantly recorded among the patients with EHMs (46.1% vs. 12.9%; p=0.000). Sustained virological response among the patients with and without EHMs rated 56.9% and 70.8% respectively (p=0.125). Patients with CHC and EHMs treated with combined Peg-IFN-alpha-2a and ribavirin experience handling difficulties, more often have serious adverse events, while successful outcome is achieved in about 50% of patients.