Thinking Outside the Liver

When you hear the disease “hepatitis C,” you most likely think of the liver. It makes sense, since the liver is ground zero of hepatitis C viral damage. However, about three-quarters of people infected with the hepatitis C virus (HCV) will also have symptoms beyond their livers.

Thinking Outside the Liver
Thinking Outside the Liver

The best documented non-liver problem caused by hepatitis C is cryoglobulinemia. Cryoglobulinemia is a blood disorder triggered by abnormal proteins (called cryoglobulins) in the blood which build up in small- and medium-sized blood vessels. People with cryoglobulinemia tend to have red, blotchy skin, joint pain, and/or overall pain. Cryoglobulinemia can also affect specific areas of the body (such as the skin, kidneys, nerves, or joints) causing health problems, such as:

• Vasculitis
• Peripheral neuropathy
• Raynaud’s phenomenon
• Non-Hodgkin’s lymphoma

Other non-liver health problems caused by the hepatitis C virus include fatigue, paresthesias, muscle pain, arthritis, severe itching, dry mouth and eyes, insulin resistance, type 2 diabetes, kidney disease, lung abnormalities, and thyroid disease.

The latest research by Dr. Nicola Fletcher and colleagues from the Hepatitis C Research Group at the University of Birmingham in England, helps explain just how the hepatitis C virus gains entry into non-liver parts of the body. The Hepatitis C Research Group demonstrated that human brain endothelial cells have the four main receptors needed for HCV to gain entry. In other words, liver cells are not the only cells of the body vulnerable to HCV infection.

Taking it one step further, these researchers showed that HCV infected and replicated within human brain cells. This viral replication within the central nervous system may account for some of the non-liver symptoms from hepatitis C infection. The research team even suggested that brain endothelial cells may serve as a reservoir of hepatitis C virus during anti-viral treatment.

Regardless of where a person’s HCV symptoms manifest — in the liver, joints, skin, or brain –the gold standard of treatment remains a protease inhibitor combined with two additional anti-viral medications (peginterferon alpha and ribavirin). The good news is that treating the HCV infection with this treatment cocktail generally kills the hepatitis C virus and resolves most of the non-liver health conditions, as well.

Stephen C Vogt, PharmD
President and CEO
BioPlus SP

Franks I. Hepatitis: Brain endothelial cells support HCV entry and replication. Nature Reviews Gastroenterology and Hepatology 2012 February;9(65): doi:10.1038/nrgastro.2011.259.

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