Original Articles
 

Extrahepatic manifestations of hepatitis C among United States male veterans

Hashem B. El-Serag, M.D. 1 3 *, Howard Hampel 2 3, Christine Yeh 3, Linda Rabeneck 1 3

1Section of Gastroenterology at The Houston Veterans Affairs Medical Center, Houston, TX 2Section of Health Services Research at The Houston Veterans Affairs Medical Center, Houston, TX 3Department of Medicine at Baylor College of Medicine, Houston, TX

email: Hashem B. El-Serag (hasheme@bcm.tmc.edu)

^*Correspondence to Hashem B. El-Serag, The Houston Veterans Affairs Medical Center (152), 2002 Holcombe Blvd., Houston, TX 77030. fax: 713-748-7359.

Funded by:
 VA Health Services Research and Development (HSR&D) Research Career Development to H.B.E.-S.; Grant Number: RCD 00-013-2
 Schering Pharmaceutical (to H.B.E.-S.)
 National Institutes of Health Career Award to L.R.; Grant Number: K24 DK59318

 

Abstract

Hepatitis C virus (HCV) has been associated with several extrahepatic conditions. To date, most studies assessing these associations involved small numbers of patients and lacked a control group. Using the computerized databases of the Department of Veterans Affairs, we carried out a hospital-based case-control study that examined all cases of HCV-infected patients hospitalized during 1992 to 1999 (n = 34,204) and randomly chosen control subjects without HCV (n = 136,816) matched with cases on the year of admission. The inpatient and outpatient files were searched for several disorders involving the skin (porphyria cutanea tarda [PCT], vitiligo, and lichen planus); renal (membranous glomerulonephritis [GN] and membranoproliferative glomerulonephritis); hematologic (cryoglobulin, Hodgkin's and non-Hodgkin's lymphoma [NHL]); endocrine (diabetes, thyroiditis); and rheumatologic (Sjögren's syndrome). The association between HCV and these disorders was examined in multivariate analyses that controlled for age, gender, ethnicity, and period of military service. Patients in the case group were younger in age (45 vs. 57 years), were more frequently nonwhite (39.6% vs. 26.3%), and were more frequently male (98.1% vs. 97.0%). A significantly greater proportion of HCV-infected patients had PCT, vitiligo, lichen planus, and cryoglobulinemia. There was a greater prevalence of membranoproliferative GN among patients with HCV but not membranous GN. There was no significant difference in the prevalence of thyroiditis, Sjögren's syndrome, or Hodgkin's or NHL. However, NHL became significant after age adjustment. Diabetes was more prevalent in controls than cases, but no statistically significant association was found after adjustment for age. In conclusion, we found a significant association between HCV infection and PCT, lichen planus, vitiligo, cryoglobulinemia, membranoproliferative GN, and NHL. Patients presenting with these disorders should be tested for HCV infection.

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Received: 21 June 2002; Accepted: 22 September 2002