Professor Graham Foster - 2007
Chronic infection with the hepatitis C virus (HCV) is associated with a wide spectrum of liver disease ranging from minor inflammation to life threatening, decompensated cirrhosis.
In addition to the effects on the liver it is now clear that HCV can also cause a variety of other symptoms and in this article I will outline some of the common complaints experienced by some patients with chronic HCV. It is important to recognise that these ‘non-hepatic’ manifestations are highly variable – many patients with chronic HCV feel absolutely normal and have no symptoms or problems at all. However other patients do suffer from quite severe symptoms that are almost certainly related to the infection.
Many patients with chronic HCV complain of difficulties in concentrating. This is a difficult sensation to describe and sufferers often complain of feeling ‘woolly headed’ and ‘just not quite on the ball’. Some sufferers have used the term ‘brain fog’ to describe these odd symptoms of poor concentration, poor memory and difficulty in completing complex mental tasks. Sadly these symptoms are relatively common but in many sufferers successful antiviral therapy does improve the symptoms and many patients who have successfully eradicated the virus find that their concentration and memory returns to normal.
Another common mental complaint is of chronic fatigue. The severity of this is highly variable – some sufferers are able to complete a full days work but then feel exhausted in the evening, others are unable to work and find that they spend very large amounts of time sleeping. One characteristic of HCV associated fatigue is that sleep does not seem to solve the problem and many patients complain that they wake up feeling as if they have never gone to sleep. This ‘non-refreshing sleep’ is common in many conditions that are associated with chronic fatigue and it is not unique to chronic HCV. Once again the fatigue associated with chronic HCV often improves with successful therapy.
In addition to the mental problems associated with chronic HCV infection many patients also suffer from generalised aches and pains. A large number of patients complain of occasional sharp pains over the liver (which is found in the upper right corner of the abdomen) and these can sometimes be very alarming. These liver pains are not necessarily associated with severe liver disease and many patients with mild hepatitis suffer from quite severe pains over the liver. Sadly pains over the liver often persist for some time after successful therapy but, in most patients, they seem to resolve with time. Sometimes the pains in the upper part of the abdomen spread to involve the rest of the abdomen and, occasionally patients complain of generalised abdominal pains that can cause quite severe discomfort.
Many patients with chronic HCV suffer from aches and pains in their joints. In my experience a large number of different joints can be involved but the commonest joints that ache are those in the hands and wrists. The pains are often minor but, occasionally, the pain can be quite severe and some patients find that they need strong painkillers to improve their symptoms.
In addition to the common symptoms outlined above many patients with chronic hepatitis C complain of a wide variety of different health related problems. These include dry eyes, irritable bowel and irritable bladder type symptoms and a host of other unpleasant problems. It is not clear whether these symptoms are related to hepatitis C infection or not – all of these disorders are common and may be increased by stress and hence they are not necessarily directly linked to infection with hepatitis C, although the stress associated with the infection may exacerbate, or possibly induce, the symptoms. Until we understand more about the way in which hepatitis C does induce symptoms it is difficult to say whether or not these symptoms are caused by the virus or not.
It is important to remember that chronic hepatitis C is common and that many patients with chronic hepatitis C will also develop other, non-hepatitis, related symptoms. It is therefore very dangerous to assume that all of your aches and pains are related to your hepatitis – for example thyroid disease, which can cause fatigue, is common in patients with chronic HCV and patients with hepatitis C are not protected from other causes of abdominal pain, like everyone else they can develop stomach ulcers and gall stones. Hence your symptoms need to be properly investigated to ensure that HCV is responsible for your aches and pains and it is potentially very dangerous to assume that everything is hepatitis C related. You should discuss your symptoms with your doctor who should be able to arrange appropriate investigations to exclude other common disorders.
