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Hepatitis C: Disease course and symptoms

When the virus affects other organs

Although hepatitis C is a viral disease of the liver, it can also cause diseases in other organs. These diseases and/or symptoms outside the liver are called 'extrahepatic manifestations'. According to a French study, three-quarters of people with hepatitis C have at least one extrahepatic disorder.1,2,3,4 The following complications occur relatively frequently:

  • Joint and muscle pains
  • Kidney damage
  • Depression and anxiety
  • Changes to the skin and mucous membranes
  • Lack of energy and tiredness
  • Cardiovascular disease and type 2 diabetes.

Possible, but somewhat rarer, symptoms are anaemia (reduced level of red blood cells), skin and thyroid diseases.

A small proportion of people with HCV, particularly women, develop autoimmune disorders of varying severity. These include:

  • Vasculitis: a painful blood circulation disorder.
  • Autoimmune thyroid disease.
  • Autoimmune hepatitis: this is a more serious form of liver disease than viral infection.
  • Glomerulonephritis: a serious form of kidney disease in which the blood filtering function becomes impaired.
  • Polyarthritis: multiple joint pains and swelling.
  • Cryoglobulinaemia: a condition in which abnormal proteins called cryoglobulins form in the blood.
  • Porphyria cutanea tarda: a condition in which by-products of haemoglobin production build up in the body.
  • Scleroderma: hardening of the skin.
  • Sicca syndrome: a chronic condition characterised by dry eyes and dry mouth.

HCV infects the lymphatic system as well as the liver and the blood. Nearly all people with hepatitis C have virus in their lymphatic vessels and organs. Hepatitis C has also been linked to low blood cell counts and to diabetes and other metabolic disorders.


  1. Cacoub P et al. Extrahepatic manifestations of chronic hepatitis C. MULTIVIRC Group. Multidepartment Virus C. Arthritis Rheum 42: 2204-2212, 1999
  2. Ferri C et al. HCV-related autoimmune and neoplastic disorders: the HCV syndrome. Dig Liver Dis 39 (Suppl 1):S13-S21, 2007
  3. Carta MG et al. Association of chronic hepatitis C with major depressive disorders: irrespective of interferon-alpha therapy. Clin Pract Epidemol Ment Health 3: 22, 2007
  4. Zignego AL et al. Extrahepatic manifestations of Hepatitis C Virus infection: a general overview and guidelines for a clinical approach. Dig Liver Dis 39: 2-17, 2007