FREQUENCY OF VARIOUS EXTRAHEPATIC MANIFESTATIONS OF CHRONIC HEPATITIS C IN PATIENTS PRESENTING IN A TERTIARY CARE HOSPITAL

Abstract

Background: Chronic hepatitis C virus (HCV) infection is a systemic disease associated with a wide range of extrahepatic manifestations that significantly contribute to patient morbidity. These complications, including hematological, autoimmune, metabolic, dermatological, and lymphoproliferative disorders, often remain underdiagnosed, particularly in resource-limited settings. Understanding their frequency and pattern is critical for guiding comprehensive management strategies.

Aim: This study aimed to determine the frequency and types of extrahepatic manifestations among patients with chronic HCV infection presenting at a tertiary-care hospital in Lahore, Pakistan.

Methodology: A cross-sectional study was conducted in the Department of Medicine, Omer Hospital, Lahore, from 13 March 2025 to 13 July 2025. Using consecutive non-probability sampling, 175 patients aged 20–70 years with confirmed chronic HCV were enrolled. Patients with HIV, HBV, CMV, EBV co-infection, chronic renal failure, or hypothyroidism were excluded. Demographic and clinical data were collected, and patients were systematically evaluated for extrahepatic manifestations including cryoglobulinemia, thrombocytopenia, diabetes, thyroid disorders, lichen planus, rheumatoid arthritis, cardiovascular and cerebrovascular diseases, chronic kidney disease, and lymphoma. Data were analyzed using SPSS version 25, applying descriptive statistics, stratification, and chi-square testing with a significance threshold of p < 0.05.

Results: Among 175 patients (mean age 45.1 ± 10.8 years; 52% male), the most frequent extrahepatic manifestation was mixed cryoglobulinemia in 65 patients (37.1%), followed by thrombocytopenia in 48 patients (27.6%) and autoimmune thyroiditis in 28 patients (16.0%). Cutaneous manifestations were observed in 8 patients (4.6%), with lichen planus present in 3 patients (1.7%). Diabetes was detected in 7 patients (4.0%), while only one patient (0.6%) was diagnosed with B-cell lymphoma. Correlation analysis demonstrated significant associations between extrahepatic manifestations and older age, longer duration of HCV infection, and advanced fibrosis (p < 0.05).

Conclusion: Extrahepatic manifestations were common in patients with chronic HCV, with cryoglobulinemia, thrombocytopenia, and thyroid autoimmunity being most prevalent. These findings emphasize the need for systematic screening and multidisciplinary management to address the full spectrum of HCV-related morbidity, beyond hepatic disease alone.