Zusammenfassung
Die chronische HCV-Infektion wird heute als eine infektiöse Systemerkrankung verstanden.
Mehr als die Hälfte der Patienten mit chronischer Hepatitis-C-Infektion entwickelt
im Verlauf ihrer Erkrankung eine extrahepatische Manifestation. Nicht selten stellen
extrahepatische Manifestationen den einzigen klinischen Hinweis auf eine chronische
HCV-Infektion dar. Bei unklaren Symptomen bzw. Kranheitsbildern des rheumatischen,
hämatologischen, endokrinen und dermatologischen Formenkreises sowie bei chronischer
Müdigkeit und Abgeschlagenheit sollte immer eine HCV-Infektion ausgeschlossen werden.
Der HCV-Lymphotropismus und die Bildung von Kryoglobulinen spielen in der Pathogenese
der extrahepatischen Manifestationen eine besondere Rolle. Für zahlreiche der mit
der HCV-Infektion beschriebene extrahepatische Manifestationen sind jedoch die pathogenetischen
Mechanismen unklar. Die Eradikation der chronischen Virusinfektion mittels antiviraler
Kombinationstherapie stellt die Behandlung der Wahl bei extrahepatischen Manifestationen
dar. Meist besteht eine enge Korrelation zwischen virologischer und klinischer Response.
In seltenen Fällen, insbesondere bei HCV-assoziierten Zytopenien und Neuropathien,
kann es durch die antivirale Therapie zu einer Aggravation der extrahepatischen Manifestation
kommen. Bei der Therapieentscheidung müssen deshalb die Form der Organbeteiligung
sowie der Schweregrad und Verlauf der Erkrankung berücksichtigt werden. Immusuppressiva,
Plasmapherese und in jüngster Zeit insbesondere auch Rituximab stellen wichtige weitere
Therapieoptionen dar, die entweder alternativ oder komplementär eingesetzt werden
können.
Abstract
Current data suggest that HCV infection should be regarded as a systemic infectious
disease with multiorgan involvement. More than 50 % of HCV-positive patients develop
during the course of the disease at least one extrahepatic manifestation (EHM). The
EHMs are often the first and only clinical signs of a chronic hepatitis C. Evidence
of HCV infection should always be sought out in cases of unspecific chronic fatigue
and/or rheumatic, haematological, endocrine or dermatological disorders. Key pathogenetic
factors for the development of EHM are undisputably the HCV lymphotropism and cryoglobulinaemia.
Nevertheless, the exact pathogenesis of many EHM still remains unclear. The therapeutic
approach to EHM should concentrate on the eradication of HCV. Antiviral therapy in
the form of peg-interferon and ribavirin should be regarded as the first-line therapy.
Viral response leads mostly to a consecutive clinical response. However, in the case
of HCV-related cytopaenias or neuropathies, antiviral therapy may trigger an aggravation
of these conditions. Thus, organ-involvement, severity and course of the EHM should
be always taken into account when choosing the appropriate therapeutic strategy. Immunosuppressive
drugs, plasmapheresis and lately rituximab are counted among therapies that can be
applied complementarly or alternatively to the antiviral therapy.
Schlüsselwörter
Virushepatitis - Leber - Hepatitis C
Key words
viral hepatitis - liver - hepatitis C
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Prof. Dr. Thomas Berg
Medizinische Klinik m. S. Hepatologie und Gastroenterologie, Charité, Campus Virchow-Klinikum,
Universitätsmedizin Berlin
Augustenburger Platz 1
13353 Berlin
Telefon: + + 49/30/4 50 55 30 71
Fax: + + 49/30/4 50 55 39 03
eMail: thomas.berg@charite.de
