Several conditions are associated with hepatitis C. People with another form of hepatitis, HIV, hemophilia, kidney disease, and diabetes have a higher rate of infection with the hep C virus (HCV) than the general population.
Some conditions are spread the same way as HCV, including other viruses like hepatitis B, and HIV. It’s also possible to get HCV as the result of a blood transfusion or organ transplant given to treat a disease like hemophilia or kidney disease.
In some cases, the increased rate of HCV is unexplained. A recent study suggested that people with diabetes have a higher prevalence of HCV infection than the general population. The researchers are unsure why.
The course of hepatitis C -- and its treatment -- may change when it coexists with other medical conditions. And the course and treatment of other conditions can be affected by HCV, too.
Cryoglobulinemia and Hepatitis C
The condition most commonly linked with hep C is cryoglobulinemia. This condition is due to the presence of abnormal antibodies (called cryoglobulins) that come from hepatitis C virus stimulation of lymphocytes (white blood cells). These antibodies can deposit in small blood vessels and cause inflammation of the vessels (vasculitis) in tissues throughout the body including the skin, joints, and kidneys (glomerulonephritis).
Some people with cryoglobulinemia have no symptoms. But they may include:
- Joint pain or swelling (arthralgia or arthritis)
- A raised, purple skin rash (palpable purpura) usually in the lower portion of the legs
- Swelling of the legs and feet due to loss of protein in the urine from the kidney involvement
- Nerve pain (neuropathy)
People with cryoglobulinemia may develop Raynaud's phenomenon, in which the fingers and toes turn color (white, then purple, then red) and become painful in low temperatures.
The diagnosis of cryoglobulinemia is made by doing a special test in a lab to detect the cryoglobulins in the blood. In this test, the cryoglobulins are identified when the blood sample is exposed to the cold (cryo means cold). In addition, a finding of typical inflammation of small blood vessels in certain tissue biopsies (for example, the skin or kidney) supports the diagnosis of cryoglobulinemia. Symptoms of cryoglobulinemia often resolve with successful treatment of the hepatitis C virus infection.
HCV and Other Types of Hepatitis
It’s not unusual for people with HCV to also be infected with another hepatitis virus. Researchers have noted that liver failure and even death can happen in people with chronic hepatitis C who are also infected with the hepatitis A virus (HAV). HCV and Hepatitis B (HBV) have shared modes of transmission. About 10% of people with HCV are thought to also be infected with HBV. Some studies have found that people infected with both HCV and HBV have a very aggressive course of disease and are at higher risk of developing cirrhosis (liver scarring) and liver failure. Anyone with HCV who hasn’t been exposed to HAV or HBV is urged to get vaccinations against these other hepatitis viruses.
Autoimmune hepatitis is also associated with other autoimmune disorders, among them diabetes. Researchers are examining these associations to try to understand why people with diabetes, on average, also have a high rate of HCV infection.
Hepatitis C and HIV
Co-infection with hepatitis C and HIV happens due to a common mode of transmission. Studies have estimated that up to 25% of people are co-infected. People with both HCV and HIV tend to have higher viral counts of HCV in their blood and livers, compared with people infected only with hepatitis C.
HIV appears to speed up HCV disease progression. People with both viruses appear to have a higher chance of cirrhosis than people infected with HCV alone. But HCV appears to have no effect on the progression of HIV to AIDS.
Co-infection appears to increase the chance of hep C being transmitted through sex. It also appears to increase the chance that mothers will infect their unborn child with the virus. This may be due, in part, to a high viral count.
Treatment for HCV infection shouldn’t be withheld because a person has HIV. Advances in hepatitis C drugs have led to the development of highly effective direct-acting antivirals. These FDA-approved drugs need to be chosen with careful attention to the complex drug interactions of the antiretroviral medications used to treat HIV.
Hepatitis C and Hemophilia
Before routine and effective hepatitis C screening of the blood supply was established in 1992, many people with hemophilia were given HCV-infected blood products. As much as 80% of people with hemophilia carry HCV, but the percentage is declining year after year.
Although some people with hemophilia were infected with HCV multiple times, from multiple blood products, their disease progression does not appear to be any more severe than the disease progression in HCV-infected people without hemophilia. There are effective treatments for people with HIV who also have hemophilia if their condition isn’t complicated with the HIV infection.
Hepatitis C and Kidney Transplantation
Approximately 10% to 49% of people who’ve had kidney transplants have antibodies for hepatitis C in their blood. Chronic HCV infection in these people appears to carry twice the risk of a serious post-transplant infection, compared to kidney transplant patients who don’t test positive for HCV antibodies. But there’s no indication that HCV-infected kidney transplant recipients have a higher rate of transplant rejection or death.
As in the general population, co-infection with both hepatitis C and hepatitis B appears to speed up disease progression in kidney transplant patients, increasing their risk of liver failure and death.
Hepatitis C and Hemodialysis
Hemodialysis patients have become infected with hepatitis C through blood transfusions, organ transplants, and, possibly, though hemodialysis equipment. About 8% of hemodialysis patients in the U.S. have HCV.
Chronic HCV infection appears to speed up the progression of kidney disease in hemodialysis patients.
Hepatitis C and Diabetes
There appears to be a connection between hepatitis C and diabetes. One study reported that people with diabetes had four times the rate of HCV infection than those without diabetes.
Another study reported that of 100 patients with cirrhosis, 34 had HCV infection. Of those, 17 (50%) had concurrent diabetes. Of the 66 HCV-free patients, only six (9%) had concurrent diabetes.
Other studies also suggest that diabetes is more prevalent in people with HCV infection than in people with other liver diseases -- even when a family medical history and other risk factors for diabetes are considered.
B-Cell Non-Hodgkin's Lymphoma and Hepatitis C
B-cell non-Hodgkin's lymphoma, a cancer of the lymph tissue, has also been associated with chronic hepatitis C virus. The cause is thought to be the excessive stimulation by the hepatitis C virus of B-lymphocytes, which results in the abnormal reproduction of the lymphocytes. Interestingly, treatment with interferon therapy and some newer direct-acting antiviral treatments have caused some cases of hepatitis C virus-associated low-grade (not very active) non-Hodgkin's lymphoma to go into remission. But most people with hepatitis C virus-associated high-grade non-Hodgkin's lymphoma will need the usual anti-cancer therapies.
Skin and Arthritis Conditions and Hepatitis C
Two skin conditions, lichen planus and porphyria cutanea tarda, have been associated with chronic hepatitis C virus. Porphyria cutanea tarda may go away with successful interferon therapy for the hepatitis C virus. But there have been cases where lichen planus actually got worse during interferon treatment.
Many people with the hepatitis C virus have autoimmune antibodies, such as anti-nuclear antibody, anti-smooth muscle antibodies, and rheumatoid factor. But true rheumatoid arthritis is uncommon in people with hepatitis C virus.