HCV syndrome: A constellation of organ- and non-organ specific autoimmune disorders, B-cell non-Hodgkin’s lymphoma, and cancer

Abstract

The clinical course of chronic hepatitis C virus (HCV) infection is characterized by possible development of both liver and extrahepatic disorders. The tropism of HCV for the lymphoid tissue is responsible for several immune-mediated disorders; a poly-oligoclonal B-lymphocyte expansion, commonly observed in a high proportion of patients with HCV infection, are responsible for the production of different autoantibodies and immune-complexes, such as mixed cryoglobulins. These serological alterations may characterize a variety of autoimmune or neoplastic diseases. Cryoglobulinemic vasculitis due to small-vessel deposition of circulating mixed cryoglobulins is the prototype of HCV-driven immune-mediated and lymphoproliferative disorders; interestingly, in some cases the disease may evolve to frank malignant lymphoma. In addition, HCV shows an oncogenic potential as suggested by several clinico-epidemiological and laboratory studies; in addition to hepatocellular carcinoma that represents the most frequent HCV-related malignancy, a causative role of HCV has been largely demonstrated in a significant percentage of patients with isolated B-cells non-Hodgkin's lymphomas. The same virus may be also involved in the pathogenesis of papillary thyroid cancer, a rare neoplastic condition that may complicate HCV-related thyroid involvement. Patients with HCV infection are frequently asymptomatic or may develop only hepatic alteration, while a limited but clinically relevant number can develop one or more autoimmune and/or neoplastic disorders. Given the large variability of their prevalence among patients' populations from different countries, it is possible to hypothesize a potential role of other co-factors, i.e., genetic and/or environmental, in the pathogenesis of HCV-related extra-hepatic diseases.

Hepatitis C virus infection and chronic kidney disease: Time for reappraisal

“…Mixed cryoglobulinemia vasculitis (CryoVas) is an immune complex small vessel vasculitis involving mainly the skin, the joints, the peripheral nerve system and the kidneys [1,2]. Main symptoms include purpura, arthralgia, peripheral neuropathy, glomerulonephritis, and, less commonly, digestive, cardiac or central nervous system vasculitis.…”

“…HCV has induced tremendous morbidity and mortality mainly due to liver complications (cirrhosis, hepatocellular carcinoma). In addition, many extrahepatic manifestations have been reported to be associated to chronic HCV infection with increased related morbidity and mortality including cardiovascular diseases, type 2 diabetes and insulin resistance, neurocognitive dysfunction, systemic vasculitis, B cell non-Hodgkin lymphoma and chronic kidney disease (CKD) [1,2]. Patients chronically infected by HCV do present a high risk of chronic renal impairment with increased morbidity and mortality linked to it (Fig.…”

Primary Pancreatic Malignant Lymphoma Diagnosed from Endoscopic Ultrasound-guided Fine-needle Aspiration Findings

“…With the exception of the male predominance, these trends were consistent with the characteristics of the present case. On the other hand, anti-HCV antibody was detected in our patient and she was considered to be in a post-infection state of hepatitis C. There are several reports of patients with malignant lymphoma and a history of HCV infection (5,6), and the tropism of the lymphoid tissue, which occurs in HCV, has been suggested to be responsible for several immune-mediated disorders such as mixed cryoglobulinemia (7). At the present time, however, there is no accepted evidence to show that HCV induces the carcinogenesis of B-cells.…”

Co-infezione HIV/HCV e malattia renale: un binomio “scindibile”

“…In tale situazione, la paziente poteva beneficiare della sola terapia farmacologica immunosoppressiva come unica arma per ottenere un miglioramento. Inoltre, nel caso descritto, si evidenziava la presenza anche di un'altra patologia immuno-mediata, l'epatite autoimmune, patologia che è stata in passato legata in maniera controversa all'infezione cronica da HCV (6,7). Nei casi dubbi, le attuali linee guida EASL (European Association for the Study of the Liver) suggeriscono di trattare in prima istanza il virus dell'HCV, con regimi interferon-free, e solo in caso di persistenza di patologia infiammatoria considerare la diagnosi di epatite autoimmune (8).…”