Chronic hepatitis C: symptoms
Last reviewed: 23.04.2024
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Chronic hepatitis C symptoms may not manifest, that is, the course is completely asymptomatic, and the diagnosis is usually established when examining blood donors or with a routine biochemical study. Such patients are characterized by prolonged periods of normal serum transaminase activity, despite the existence of histologically confirmed chronic hepatitis. Persistence of serum HCV-RNA may be noted.
Weakness is the main symptom of chronic hepatitis C. Periodically, poor health is noted.
Targeted interrogation can identify such risk factors as blood transfusion or intravenous drug use. There may be no indication of risk factors.
Symptoms of chronic hepatitis C are slow and accompanied by significant fluctuations in the activity of transaminases over many years. Each increase in transaminase activity probably reflects an episode of viremia, which may be due to different quasi-species. Liver insufficiency develops only after 10 years or more from the onset of the disease. Before that, many patients, especially those who underwent blood transfusion, are dying from other causes. Explicit signs of portal hypertension are rare, splenomegaly at the time of treatment is detected only in half of patients. Bleeding from varicose-dilated esophagus veins is characteristic of the late stage of the disease. Thrombocytopenia develops with an increase in spleen.
With objective examination, short-term jaundice, hemorrhagic phenomena (hemorrhagic rash on the skin), subfebrile body temperature are detected. When examining the organs of the abdominal cavity, hepatomegaly is detected (the enlarged liver is dense and painful), often splenomegaly.
In the clinical picture of chronic hepatitis C, numerous extrahepatic symptoms (vasculitis, membranous-proliferative glomerulonsphritis, cryoglobulinemia, pneumofibrosis, Sjogren's syndrome, late cutaneous porphyria, uveitis, keratitis) should be considered. In recent years, the development of bone marrow aplasia in hepatitis C has been reported, mainly in patients from Asian countries. Extrahepatic symptoms of chronic hepatitis C are due to the ability of the hepatitis C virus to extrahepatic replication, and renal damage - circulating in the blood with HCV-Ag-containing immune complexes.
[Extrahepatic symptoms of chronic hepatitis C
Symptoms of chronic hepatitis C can be accompanied by various immune disorders.
Approximately one third of patients with essential mixed cryoglobulinemia are detected markers of HCV infection. Serum contains complexes that include HCV and HCV virions antigen-antibody. HCV-antigen is also found in the tissues of the liver and skin. Clinically, HCV infection manifests as systemic vasculitis with purpura, neuropathy and Raynaud's syndrome (in a small proportion of patients). Some patients respond to interferon therapy.
With membranous glomerulonephritis, glomerular immune complexes containing HCV, anti-HCV, IgG, IgM and rheumatoid factor are detected. Interferon therapy can be effective.
Lymphocytic sialadenitis, resembling Sjogren's syndrome, is described, but without symptoms of dry syndrome.
There is a connection with thyroiditis, even in patients not treated with interferon.
There was also a close connection with late cutaneous porphyria; HCV can become a trigger factor in people predisposed to this disease.
Red flat lichen is associated with chronic liver diseases, including hepatitis C.
The combination with alcoholic liver disease is manifested by more severe viremia and more severe liver damage.