Impact of hepatitis C on wider health

Autoimmune thyroid dysfunction

The thyroid gland is the largest of the endocrine glands, a system which secretes hormones into the circulatory system to be carried towards your organs.

The thyroid gland’s main function is to increase the rate at which the body’s cells chemically react, especially the energy and protein reactions.

There are two conditions associated with hepatitis C infection where the immune system can either attack or stimulate thyroid tissue:

·         Over-reactive thyroid production (hyperthyroidism) can cause insomnia, weight loss, palpitations and ankle swelling

·         Under-active thyroid production (hypothyroidism) can cause physical and mental sluggishness.

With hepatitis C, thyroid autoimmune dysfunction is more common among women.

Type 2 diabetes & insulin resistance

Insulin resistance is a condition where there is too much insulin your blood. The blood cells that normally absorb the insulin begin to refuse it. This results in your body not being able to absorb or process sugars properly. Insulin resistance alone does not cause type 2 diabetes, but it can increase the risk of developing it.

Despite several studies associating hepatitis C and type 2 diabetes, the exact mechanism of the relationship between hepatitis C and insulin resistance is unclear. Some studies have indicated that people with severe liver fibrosis and cirrhosis are more likely to develop type 2 diabetes.

Symptoms of diabetes include needing to urinate more than usual, feeling very thirsty, feeling very tired and unexplained weight loss.

Heart disease

Hepatitis C infection is associated with a higher risk of coronary heart disease (CHD), also known as coronary artery disease. This is the most common type of heart disease. Although studies have highlighted a link, the mechanism which associates hepatitis C infection and CHD is unclear.

Coronary heart disease is caused by a build-up of a material called plaque in the arteries that supply blood to the heart. This causes the arteries to narrow, slowing or stopping the blood flow towards the heart. This process is called atherosclerosis.

The most common symptom of CHD is chest pain (also known as angina), although it can also lead to heart attacks and heart failure. CHD cannot be cured, but treatment and lifestyle changes can manage symptoms.

Gallbladder Disease

Some people with hepatitis C develop problems with their gallbladder, particularly in those with more severe liver disease. This can lead to inflammation and pain causing nausea and possibly vomiting. It may also cause difficulty when eating certain foods, especially fatty foods. Cirrhosis is a known risk factor for gallstones, and they may develop in some cases.

As humans don’t need a gallbladder, it is not uncommon for people with hepatitis C to have it removed as a result of gallbladder disease.

Arthritis

Different forms of arthritis have been associated with hepatitis C infection, but the most commonly linked type is rheumatoid arthritis (RA). RA normally affects the synovial joints (which are most joints in the body). These joints have a space between the bones filled with a liquid called synovial fluid. RA causes membranes in these joints to overgrow leading to inflammation of their linings. Symptoms include pain, swelling, redness and stiffness.

As the condition progresses, surrounding cartilage, tendons and bone may be damaged which could affect joint movement. It is generally thought that HCV-related RA is an autoimmune disorder that results in antibodies attacking normal body tissue.

Some doctors also think it may be more closely related to liver damage. The fact that the condition usually affects people who have developed cirrhosis seems to support this.

Cryoglobulinemia

This is a disorder in which abnormal proteins may cause damage to the skin, the nervous system and the kidneys. Symptoms include mild fatigue, joint pains, or itching and increased sensitivity to temperature changes.

Occasionally, people with cryoglobulinemia develop inflammation of the blood vessels (vasculitis). This can cause purple skin lesions (purpura) or numbness in the hands and feet. It can also cause ‘Raynaud’s phenomenon’, where the hands turn white, then blue, and then red from constriction and dilation of the blood vessels. 

Non-Hodgkins Lymphoma

Lymphoma is cancer of the cells in the lymphatic system, which is the part of the body’s immune and circulation systems. There are two main types of lymphoma. One is called Hodgkin’s disease, named after the doctor who first described it. The other is called non-Hodgkin’s lymphoma or NHL. NHL is a group of around twenty types of cancer which affect the body’s lymphatic system.

There is a connection between hepatitis C and NHL with research showing that hepatitis C significantly increases the risk of developing Non-Hodgkins Lymphoma.

HCV frequently inhabits the lymphatic system in low quantities. As hepatitis C was often seen as only infecting the liver, the connection between hepatitis C and NHL was only recently made. This resulted in cases of lymphoma being underreported.

The primary symptoms of lymphatic diseases are:

·         Painless swelling of the lymph nodes - usually in the neck, armpits or groin

·         Excessive sweating or fever

·         Persistent itching all over the body

·         Weight loss and loss of appetite

Lymphoma is detected by taking a biopsy from a suspect lymph node. It has been known for some time that people infected with hepatitis C and long-term cryoglobulinema are at greater risk of NHL. NHL is now also known to develop in people who do not suffer from cryoglobulinemia.

Parkinson’s Disease

HCV has been identified as a potential risk factor for Parkinson’s Disease as it is possible that the hepatitis C infection can invade the central nervous system. Studies have suggested that there is an association between hepatitis C and Parkinson’s Disease.

Parkinson’s is a progressive neurological condition caused by a loss of nerve cells in the brain. This leads to a reduction in a chemical called dopamine in the brain. It causes symptoms such as tremor (involuntary shaking of body parts), slow movement and rigidity.

The mechanism of how hepatitis C can cause Parkinson’s has only recently been studied, but it appears that an inflammatory protein called cytokines may be released by the hepatitis C infection and this could play a role in the pathogenesis of Parkinson’s Disease.

Jaundice

Jaundice is a key sign of decompensated cirrhosis. It only affects a few patients with acute hepatitis and also very few people living with chronic hepatitis C. If you experience this development, you should contact a medical professional as soon as possible as survival rates are low for people who develop decompensated cirrhosis.

It causes a yellow appearance of the skin, which comes from the pigment bilirubin. This pigment gives bile its green/yellow colour. It is formed during the breakdown of old blood cells.

If the liver loses the ability to remove bile pigment, it builds up in the blood and the skin. The whites of the eyes then go yellow, skin shows a yellow hue, urine goes brown and faeces can turn white.

Cognitive impairment

Hepatitis C infection has been associated with cognitive dysfunction. Roughly 50% of patients typically feel cognitive impairment, highlighting issues such as ‘brain fog’ and mental tiredness. These issues can interfere with people’s ability to perform activities as they normally would do.

 

Studies have indicated that the hepatitis C virus infection can spread into microglia and astrocytes, two types of cells which occur in the central nervous system in the brain and spinal cord. Microglia are the main force of immune defense in the central nervous system. They act as a form of protection against cognitive impairment, and a recent study recorded increased microglia activation in patients with cognitive dysfunction. This occurs because these cells are working to protect the brain from the virus.

 

 

 

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