Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Extrahepatic manifestations of hepatitis C virus infection

Sanjiv Chopra, MD, MACP
Steven Flamm, MD
Section Editor
Adrian M Di Bisceglie, MD
Deputy Editor
Allyson Bloom, MD


Infection with hepatitis C virus (HCV) can lead to both acute and chronic hepatitis. In addition, there are several extrahepatic manifestations of chronic HCV infection, including [1-4]:

Hematologic diseases such as cryoglobulinemia and lymphoma

Autoimmune disorders such as thyroiditis

Renal disease

Dermatologic conditions such as lichen planus and porphyria cutanea tarda

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Mar 14, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Gumber SC, Chopra S. Hepatitis C: a multifaceted disease. Review of extrahepatic manifestations. Ann Intern Med 1995; 123:615.
  2. Pawlotsky JM, Ben Yahia M, Andre C, et al. Immunological disorders in C virus chronic active hepatitis: a prospective case-control study. Hepatology 1994; 19:841.
  3. Cacoub P, Renou C, Rosenthal E, et al. Extrahepatic manifestations associated with hepatitis C virus infection. A prospective multicenter study of 321 patients. The GERMIVIC. Groupe d'Etude et de Recherche en Medecine Interne et Maladies Infectieuses sur le Virus de l'Hepatite C. Medicine (Baltimore) 2000; 79:47.
  4. El-Serag HB, Hampel H, Yeh C, Rabeneck L. Extrahepatic manifestations of hepatitis C among United States male veterans. Hepatology 2002; 36:1439.
  5. Ferri C, Ramos-Casals M, Zignego AL, et al. International diagnostic guidelines for patients with HCV-related extrahepatic manifestations. A multidisciplinary expert statement. Autoimmun Rev 2016; 15:1145.
  6. Lunel F, Musset L, Cacoub P, et al. Cryoglobulinemia in chronic liver diseases: role of hepatitis C virus and liver damage. Gastroenterology 1994; 106:1291.
  7. David WS, Peine C, Schlesinger P, Smith SA. Nonsystemic vasculitic mononeuropathy multiplex, cryoglobulinemia, and hepatitis C. Muscle Nerve 1996; 19:1596.
  8. Gisbert JP, García-Buey L, Pajares JM, Moreno-Otero R. Prevalence of hepatitis C virus infection in B-cell non-Hodgkin's lymphoma: systematic review and meta-analysis. Gastroenterology 2003; 125:1723.
  9. Giordano TP, Henderson L, Landgren O, et al. Risk of non-Hodgkin lymphoma and lymphoproliferative precursor diseases in US veterans with hepatitis C virus. JAMA 2007; 297:2010.
  10. de Sanjose S, Benavente Y, Vajdic CM, et al. Hepatitis C and non-Hodgkin lymphoma among 4784 cases and 6269 controls from the International Lymphoma Epidemiology Consortium. Clin Gastroenterol Hepatol 2008; 6:451.
  11. Silvestri F, Pipan C, Barillari G, et al. Prevalence of hepatitis C virus infection in patients with lymphoproliferative disorders. Blood 1996; 87:4296.
  12. Monti G, Pioltelli P, Saccardo F, et al. Incidence and characteristics of non-Hodgkin lymphomas in a multicenter case file of patients with hepatitis C virus-related symptomatic mixed cryoglobulinemias. Arch Intern Med 2005; 165:101.
  13. Bronowicki JP, Bineau C, Feugier P, et al. Primary lymphoma of the liver: clinical-pathological features and relationship with HCV infection in French patients. Hepatology 2003; 37:781.
  14. Luppi M, Longo G, Ferrari MG, et al. Additional neoplasms and HCV infection in low-grade lymphoma of MALT type. Br J Haematol 1996; 94:373.
  15. De Vita S, De Re V, Sansonno D, et al. Gastric mucosa as an additional extrahepatic localization of hepatitis C virus: viral detection in gastric low-grade lymphoma associated with autoimmune disease and in chronic gastritis. Hepatology 2000; 31:182.
  16. Tursi A, Brandimante G, Chiarelli F, et al. Detection of HCV RNA in gastric mucosa-associated lymphoid tissue by in situ hybridization: evidence of a new extrahepatic localization of HCV with increased risk of gastric malt lymphoma. Am J Gastroenterol 2002; 97:1802.
  17. Rasul I, Shepherd FA, Kamel-Reid S, et al. Detection of occult low-grade b-cell non-Hodgkin's lymphoma in patients with chronic hepatitis C infection and mixed cryoglobulinemia. Hepatology 1999; 29:543.
  18. Hermine O, Lefrère F, Bronowicki JP, et al. Regression of splenic lymphoma with villous lymphocytes after treatment of hepatitis C virus infection. N Engl J Med 2002; 347:89.
  19. Wang Q, De Luca A, Smith C, et al. Chronic Hepatitis B and C Virus Infection and Risk for Non-Hodgkin Lymphoma in HIV-Infected Patients: A Cohort Study. Ann Intern Med 2017; 166:9.
  20. Pozzato G, Mazzaro C, Crovatto M, et al. Low-grade malignant lymphoma, hepatitis C virus infection, and mixed cryoglobulinemia. Blood 1994; 84:3047.
  21. Su TH, Liu CJ, Tseng TC, et al. Hepatitis C viral infection increases the risk of lymphoid-neoplasms: A population-based cohort study. Hepatology 2016; 63:721.
  22. Kawamura Y, Ikeda K, Arase Y, et al. Viral elimination reduces incidence of malignant lymphoma in patients with hepatitis C. Am J Med 2007; 120:1034.
  23. Maciocia N, O'Brien A, Ardeshna K. Remission of Follicular Lymphoma after Treatment for Hepatitis C Virus Infection. N Engl J Med 2016; 375:1699.
  24. Zignego AL, Giannelli F, Marrocchi ME, et al. T(14;18) translocation in chronic hepatitis C virus infection. Hepatology 2000; 31:474.
  25. Kitay-Cohen Y, Amiel A, Hilzenrat N, et al. Bcl-2 rearrangement in patients with chronic hepatitis C associated with essential mixed cryoglobulinemia type II. Blood 2000; 96:2910.
  26. Zuckerman E, Zuckerman T, Sahar D, et al. bcl-2 and immunoglobulin gene rearrangement in patients with hepatitis C virus infection. Br J Haematol 2001; 112:364.
  27. Zignego AL, Ferri C, Giannelli F, et al. Prevalence of bcl-2 rearrangement in patients with hepatitis C virus-related mixed cryoglobulinemia with or without B-cell lymphomas. Ann Intern Med 2002; 137:571.
  28. Quinn ER, Chan CH, Hadlock KG, et al. The B-cell receptor of a hepatitis C virus (HCV)-associated non-Hodgkin lymphoma binds the viral E2 envelope protein, implicating HCV in lymphomagenesis. Blood 2001; 98:3745.
  29. Ennishi D, Maeda Y, Niitsu N, et al. Hepatic toxicity and prognosis in hepatitis C virus-infected patients with diffuse large B-cell lymphoma treated with rituximab-containing chemotherapy regimens: a Japanese multicenter analysis. Blood 2010; 116:5119.
  30. Heer M, Joller-Jemelka H, Fontana A, et al. Monoclonal gammopathy in chronic active hepatitis. Liver 1984; 4:255.
  31. Andreone P, Zignego AL, Cursaro C, et al. Prevalence of monoclonal gammopathies in patients with hepatitis C virus infection. Ann Intern Med 1998; 129:294.
  32. Perrone A, Deramo MT, Spaccavento F, et al. Hepatitis C virus (HCV) genotypes, human leucocyte antigen expression and monoclonal gammopathy prevalence during chronic HCV infection. Cytobios 2001; 106 Suppl 1:125.
  33. Al-Shemmari SH, Siddique I, Hassan F, et al. Monoclonal gammopathy among patients with chronic hepatitis C infection. Med Princ Pract 2004; 13:88.
  34. Mangia A, Clemente R, Musto P, et al. Hepatitis C virus infection and monoclonal gammopathies not associated with cryoglobulinemia. Leukemia 1996; 10:1209.
  35. Tsianos EV, Di Bisceglie AM, Papadopoulos NM, et al. Oligoclonal immunoglobulin bands in serum in association with chronic viral hepatitis. Am J Gastroenterol 1990; 85:1005.
  36. Maruyama S, Hirayama C, Horie Y, et al. Serum immunoglobulins in patients with chronic hepatitis C: a surrogate marker of disease severity and treatment outcome. Hepatogastroenterology 2007; 54:493.
  37. Daoud MS, Gibson LE, Daoud S, el-Azhary RA. Chronic hepatitis C and skin diseases: a review. Mayo Clin Proc 1995; 70:559.
  38. Berk DR, Mallory SB, Keeffe EB, Ahmed A. Dermatologic disorders associated with chronic hepatitis C: effect of interferon therapy. Clin Gastroenterol Hepatol 2007; 5:142.
  39. Kushner JP, Barbuto AJ, Lee GR. An inherited enzymatic defect in porphyria cutanea tarda: decreased uroporphyrinogen decarboxylase activity. J Clin Invest 1976; 58:1089.
  40. Gisbert JP, García-Buey L, Pajares JM, Moreno-Otero R. Prevalence of hepatitis C virus infection in porphyria cutanea tarda: systematic review and meta-analysis. J Hepatol 2003; 39:620.
  41. Di Padova C, Marchesi L, Cainelli T, et al. Effects of phlebotomy on urinary porphyrin pattern and liver histology in patients with porphyria cutanea tarda. Am J Med Sci 1983; 285:2.
  42. CAN C, NIGOGOSYAN G. Acquired toxic porphyria cutanea tarda due to hexachlorobenzene. Report of 348 cases caused by this fungicide. JAMA 1963; 183:88.
  43. Cripps DJ, Peters HA, Gocmen A, Dogramici I. Porphyria turcica due to hexachlorobenzene: a 20 to 30 year follow-up study on 204 patients. Br J Dermatol 1984; 111:413.
  44. Cripps DJ. Diet and alcohol effects on the manifestation of hepatic porphyrias. Fed Proc 1987; 46:1894.
  45. Haberman HF, Rosenberg F, Menon IA. Porphyria cutanea tarda: comparison of cases precipitated by alcohol and estrogens. Can Med Assoc J 1975; 113:653.
  46. Grossman ME, Bickers DR, Poh-Fitzpatrick MB, et al. Porphyria cutanea tarda. Clinical features and laboratory findings in 40 patients. Am J Med 1979; 67:277.
  47. Alaizari NA, Al-Maweri SA, Al-Shamiri HM, et al. Hepatitis C virus infections in oral lichen planus: a systematic review and meta-analysis. Aust Dent J 2016; 61:282.
  48. Lodi G, Giuliani M, Majorana A, et al. Lichen planus and hepatitis C virus: a multicentre study of patients with oral lesions and a systematic review. Br J Dermatol 2004; 151:1172.
  49. Younossi Z, Park H, Henry L, et al. Extrahepatic Manifestations of Hepatitis C: A Meta-analysis of Prevalence, Quality of Life, and Economic Burden. Gastroenterology 2016; 150:1599.
  50. Nagao Y, Nishida N, Toyo-Oka L, et al. Genome-Wide Association Study Identifies Risk Variants for Lichen Planus in Patients With Hepatitis C Virus Infection. Clin Gastroenterol Hepatol 2017.
  51. Abdallah MA, Ghozzi MY, Monib HA, et al. Necrolytic acral erythema: a cutaneous sign of hepatitis C virus infection. J Am Acad Dermatol 2005; 53:247.
  52. Khanna VJ, Shieh S, Benjamin J, et al. Necrolytic acral erythema associated with hepatitis C: effective treatment with interferon alfa and zinc. Arch Dermatol 2000; 136:755.
  53. Abdallah MA, Hull C, Horn TD. Necrolytic acral erythema: a patient from the United States successfully treated with oral zinc. Arch Dermatol 2005; 141:85.
  54. Hivnor CM, Yan AC, Junkins-Hopkins JM, Honig PJ. Necrolytic acral erythema: response to combination therapy with interferon and ribavirin. J Am Acad Dermatol 2004; 50:S121.
  55. El-Ghandour TM, Sakr MA, El-Sebai H, et al. Necrolytic acral erythema in Egyptian patients with hepatitis C virus infection. J Gastroenterol Hepatol 2006; 21:1200.
  56. Ramos-Casals M, Muñoz S, Medina F, et al. Systemic autoimmune diseases in patients with hepatitis C virus infection: characterization of 1020 cases (The HISPAMEC Registry). J Rheumatol 2009; 36:1442.
  57. Clifford BD, Donahue D, Smith L, et al. High prevalence of serological markers of autoimmunity in patients with chronic hepatitis C. Hepatology 1995; 21:613.
  58. Cacoub P, Musset L, Amoura Z, et al. Anticardiolipin, anti-beta2-glycoprotein I, and antinucleosome antibodies in hepatitis C virus infection and mixed cryoglobulinemia. Multivirc Group. J Rheumatol 1997; 24:2139.
  59. Lienesch D, Morris R, Metzger A, et al. Absence of cyclic citrullinated peptide antibody in nonarthritic patients with chronic hepatitis C infection. J Rheumatol 2005; 32:489.
  60. Haddad J, Deny P, Munz-Gotheil C, et al. Lymphocytic sialadenitis of Sjögren's syndrome associated with chronic hepatitis C virus liver disease. Lancet 1992; 339:321.
  61. Ramos-Casals M, Loustaud-Ratti V, De Vita S, et al. Sjögren syndrome associated with hepatitis C virus: a multicenter analysis of 137 cases. Medicine (Baltimore) 2005; 84:81.
  62. Wang Y, Dou H, Liu G, et al. Hepatitis C virus infection and the risk of Sjögren or sicca syndrome: a meta-analysis. Microbiol Immunol 2014; 58:675.
  63. Brito-Zerón P, Gheitasi H, Retamozo S, et al. How hepatitis C virus modifies the immunological profile of Sjögren syndrome: analysis of 783 patients. Arthritis Res Ther 2015; 17:250.
  64. Zauli D, Ghetti S, Grassi A, et al. Anti-neutrophil cytoplasmic antibodies in type 1 and 2 autoimmune hepatitis. Hepatology 1997; 25:1105.
  65. Bianchi FB. Autoimmune hepatitis: the lesson of the discovery of hepatitis C virus. J Hepatol 1993; 18:273.
  66. Reddy KR, Krawitt EL, Homberg JC, et al. Absence of anti-LKM-1 antibody in hepatitis C viral infection in the United States of America. J Viral Hepat 1995; 2:175.
  67. Yamamoto AM, Cresteil D, Homberg JC, Alvarez F. Characterization of anti-liver-kidney microsome antibody (anti-LKM1) from hepatitis C virus-positive and -negative sera. Gastroenterology 1993; 104:1762.
  68. Muratori L, Lenzi M, Ma Y, et al. Heterogeneity of liver/kidney microsomal antibody type 1 in autoimmune hepatitis and hepatitis C virus related liver disease. Gut 1995; 37:406.
  69. Muratori L, Lenzi M, Cataleta M, et al. Interferon therapy in liver/kidney microsomal antibody type 1-positive patients with chronic hepatitis C. J Hepatol 1994; 21:199.
  70. Gschwantler M, Schrutka-Kölbl C, Weiss W. Acute exacerbation of antiliver cytosol antibody-positive autoimmune chronic hepatitis by alpha-interferon. Am J Gastroenterol 1995; 90:2239.
  71. Bellary S, Schiano T, Hartman G, Black M. Chronic hepatitis with combined features of autoimmune chronic hepatitis and chronic hepatitis C: favorable response to prednisone and azathioprine. Ann Intern Med 1995; 123:32.
  72. Bortolotti F, Vajro P, Balli F, et al. Non-organ specific autoantibodies in children with chronic hepatitis C. J Hepatol 1996; 25:614.
  73. Tran A, Quaranta JF, Benzaken S, et al. High prevalence of thyroid autoantibodies in a prospective series of patients with chronic hepatitis C before interferon therapy. Hepatology 1993; 18:253.
  74. Antonelli A, Ferri C, Pampana A, et al. Thyroid disorders in chronic hepatitis C. Am J Med 2004; 117:10.
  75. Roti E, Minelli R, Giuberti T, et al. Multiple changes in thyroid function in patients with chronic active HCV hepatitis treated with recombinant interferon-alpha. Am J Med 1996; 101:482.
  76. Marazuela M, García-Buey L, González-Fernández B, et al. Thyroid autoimmune disorders in patients with chronic hepatitis C before and during interferon-alpha therapy. Clin Endocrinol (Oxf) 1996; 44:635.
  77. Pawlotsky JM, Bouvier M, Fromont P, et al. Hepatitis C virus infection and autoimmune thrombocytopenic purpura. J Hepatol 1995; 23:635.
  78. Chiao EY, Engels EA, Kramer JR, et al. Risk of immune thrombocytopenic purpura and autoimmune hemolytic anemia among 120 908 US veterans with hepatitis C virus infection. Arch Intern Med 2009; 169:357.
  79. Allison ME, Wreghitt T, Palmer CR, Alexander GJ. Evidence for a link between hepatitis C virus infection and diabetes mellitus in a cirrhotic population. J Hepatol 1994; 21:1135.
  80. Fraser GM, Harman I, Meller N, et al. Diabetes mellitus is associated with chronic hepatitis C but not chronic hepatitis B infection. Isr J Med Sci 1996; 32:526.
  81. Grimbert S, Valensi P, Lévy-Marchal C, et al. High prevalence of diabetes mellitus in patients with chronic hepatitis C. A case-control study. Gastroenterol Clin Biol 1996; 20:544.
  82. Ozyilkan E, Arslan M. Increased prevalence of diabetes mellitus in patients with chronic hepatitis C virus infection. Am J Gastroenterol 1996; 91:1480.
  83. Mason AL, Lau JY, Hoang N, et al. Association of diabetes mellitus and chronic hepatitis C virus infection. Hepatology 1999; 29:328.
  84. Caronia S, Taylor K, Pagliaro L, et al. Further evidence for an association between non-insulin-dependent diabetes mellitus and chronic hepatitis C virus infection. Hepatology 1999; 30:1059.
  85. Mehta SH, Brancati FL, Sulkowski MS, et al. Prevalence of type 2 diabetes mellitus among persons with hepatitis C virus infection in the United States. Ann Intern Med 2000; 133:592.
  86. Mehta SH, Brancati FL, Strathdee SA, et al. Hepatitis C virus infection and incident type 2 diabetes. Hepatology 2003; 38:50.
  87. Zein CO, Levy C, Basu A, Zein NN. Chronic hepatitis C and type II diabetes mellitus: a prospective cross-sectional study. Am J Gastroenterol 2005; 100:48.
  88. Shintani Y, Fujie H, Miyoshi H, et al. Hepatitis C virus infection and diabetes: direct involvement of the virus in the development of insulin resistance. Gastroenterology 2004; 126:840.
  89. White DL, Ratziu V, El-Serag HB. Hepatitis C infection and risk of diabetes: a systematic review and meta-analysis. J Hepatol 2008; 49:831.
  90. Petit JM, Bour JB, Galland-Jos C, et al. Risk factors for diabetes mellitus and early insulin resistance in chronic hepatitis C. J Hepatol 2001; 35:279.
  91. Bigam DL, Pennington JJ, Carpentier A, et al. Hepatitis C-related cirrhosis: a predictor of diabetes after liver transplantation. Hepatology 2000; 32:87.
  92. Hadziyannis S, Karamanos B. Diabetes mellitus and chronic hepatitis C virus infection. Hepatology 1999; 29:604.
  93. Moucari R, Asselah T, Cazals-Hatem D, et al. Insulin resistance in chronic hepatitis C: association with genotypes 1 and 4, serum HCV RNA level, and liver fibrosis. Gastroenterology 2008; 134:416.
  94. Milner KL, van der Poorten D, Trenell M, et al. Chronic hepatitis C is associated with peripheral rather than hepatic insulin resistance. Gastroenterology 2010; 138:932.
  95. Hui JM, Sud A, Farrell GC, et al. Insulin resistance is associated with chronic hepatitis C virus infection and fibrosis progression [corrected]. Gastroenterology 2003; 125:1695.
  96. Romero-Gómez M, Fernández-Rodríguez CM, Andrade RJ, et al. Effect of sustained virological response to treatment on the incidence of abnormal glucose values in chronic hepatitis C. J Hepatol 2008; 48:721.
  97. Arase Y, Suzuki F, Suzuki Y, et al. Sustained virological response reduces incidence of onset of type 2 diabetes in chronic hepatitis C. Hepatology 2009; 49:739.
  98. Conjeevaram HS, Wahed AS, Afdhal N, et al. Changes in insulin sensitivity and body weight during and after peginterferon and ribavirin therapy for hepatitis C. Gastroenterology 2011; 140:469.
  99. Wilson SE, Lee WM, Murakami C, et al. Mooren's corneal ulcers and hepatitis C virus infection. N Engl J Med 1993; 329:62.
  100. Ali Y, Ghafouri M, Weitzman M, et al. Refractory scleritis in a patient with cryoglobulinemia and hepatitis C. J Clin Rheumatol 1999; 5:371.
  101. Moder KG, Poterucha JJ, Mahr MA. Scleritis associated with viral hepatitis C: Report of a case. J Clin Rheumatol 2000; 6:166.
  102. Jacobi C, Wenkel H, Jacobi A, et al. Hepatitis C and ocular surface disease. Am J Ophthalmol 2007; 144:705.
  103. Johnson RJ, Gretch DR, Couser WG, et al. Hepatitis C virus-associated glomerulonephritis. Effect of alpha-interferon therapy. Kidney Int 1994; 46:1700.
  104. McGuire BM, Julian BA, Bynon JS Jr, et al. Brief communication: Glomerulonephritis in patients with hepatitis C cirrhosis undergoing liver transplantation. Ann Intern Med 2006; 144:735.
  105. Levey AS, Atkins R, Coresh J, et al. Chronic kidney disease as a global public health problem: approaches and initiatives - a position statement from Kidney Disease Improving Global Outcomes. Kidney Int 2007; 72:247.
  106. Agnello V, Chung RT, Kaplan LM. A role for hepatitis C virus infection in type II cryoglobulinemia. N Engl J Med 1992; 327:1490.
  107. Johnson RJ, Gretch DR, Yamabe H, et al. Membranoproliferative glomerulonephritis associated with hepatitis C virus infection. N Engl J Med 1993; 328:465.
  108. Gallego-Rojo FJ, Gonzalez-Calvin JL, Muñoz-Torres M, et al. Bone mineral density, serum insulin-like growth factor I, and bone turnover markers in viral cirrhosis. Hepatology 1998; 28:695.
  109. Gonzalez-Calvin JL, Gallego-Rojo F, Fernandez-Perez R, et al. Osteoporosis, mineral metabolism, and serum soluble tumor necrosis factor receptor p55 in viral cirrhosis. J Clin Endocrinol Metab 2004; 89:4325.
  110. Leslie WD, Bernstein CN, Leboff MS, American Gastroenterological Association Clinical Practice Commitee. AGA technical review on osteoporosis in hepatic disorders. Gastroenterology 2003; 125:941.
  111. Lo Re V 3rd, Guaraldi G, Leonard MB, et al. Viral hepatitis is associated with reduced bone mineral density in HIV-infected women but not men. AIDS 2009; 23:2191.
  112. Rouillard S, Lane NE. Hepatic osteodystrophy. Hepatology 2001; 33:301.
  113. Lo Re V 3rd, Volk J, Newcomb CW, et al. Risk of hip fracture associated with hepatitis C virus infection and hepatitis C/human immunodeficiency virus coinfection. Hepatology 2012; 56:1688.
  114. Gilbert L, He X, Farmer P, et al. Expression of the osteoblast differentiation factor RUNX2 (Cbfa1/AML3/Pebp2alpha A) is inhibited by tumor necrosis factor-alpha. J Biol Chem 2002; 277:2695.
  115. Pignata S, Daniele B, Galati MG, et al. Oestradiol and testosterone blood levels in patients with viral cirrhosis and hepatocellular carcinoma. Eur J Gastroenterol Hepatol 1997; 9:283.
  116. Shaker JL, Moore BP, Whyte MP. Hyperparathyroidism and increased serum IGF-binding protein-2 levels in hepatitis C-associated osteosclerosis. J Clin Endocrinol Metab 1999; 84:384.
  117. Khosla S, Hassoun AA, Baker BK, et al. Insulin-like growth factor system abnormalities in hepatitis C-associated osteosclerosis. Potential insights into increasing bone mass in adults. J Clin Invest 1998; 101:2165.
  118. Butt AA, Yan P, Chew KW, et al. Risk of Acute Myocardial Infarction Among Hepatitis C Virus (HCV)-Positive and HCV-Negative Men at Various Lipid Levels: Results From ERCHIVES. Clin Infect Dis 2017; 65:557.
  119. Petta S, Maida M, Macaluso FS, et al. Hepatitis C Virus Infection Is Associated With Increased Cardiovascular Mortality: A Meta-Analysis of Observational Studies. Gastroenterology 2016; 150:145.
  120. Ambrosino P, Tarantino L, Criscuolo L, et al. The risk of venous thromboembolism in patients with hepatitis C. A systematic review and meta-analysis. Thromb Haemost 2016; 116:958.
  121. Perry W, Hilsabeck RC, Hassanein TI. Cognitive dysfunction in chronic hepatitis C: a review. Dig Dis Sci 2008; 53:307.
  122. Monaco S, Mariotto S, Ferrari S, et al. Hepatitis C virus-associated neurocognitive and neuropsychiatric disorders: Advances in 2015. World J Gastroenterol 2015; 21:11974.
  123. Forton DM, Taylor-Robinson SD, Thomas HC. Central nervous system changes in hepatitis C virus infection. Eur J Gastroenterol Hepatol 2006; 18:333.
  124. Tsai HH, Liou HH, Muo CH, et al. Hepatitis C virus infection as a risk factor for Parkinson disease: A nationwide cohort study. Neurology 2016; 86:840.