Hepatitis C: Disease course and symptoms

When the virus affects other organs

Although hepatitis C is a viral disease of the liver, it can also cause diseases in other organs. These diseases and/or symptoms outside the liver are called 'extrahepatic manifestations'. According to a French study, three-quarters of people with hepatitis C have at least one extrahepatic disorder.1,2,3,4 The following complications occur relatively frequently:

  • Joint and muscle pains
  • Kidney damage
  • Depression and anxiety
  • Changes to the skin and mucous membranes
  • Lack of energy and tiredness
  • Cardiovascular disease and type 2 diabetes.

Possible, but somewhat rarer, symptoms are anaemia (reduced level of red blood cells), skin and thyroid diseases.

A small proportion of people with HCV, particularly women, develop autoimmune disorders of varying severity. These include:



A shortage or change in the size or function of red blood cells. These cells carry oxygen to organs of the body. Symptoms can include shortness of breath, fatigue and lack of concentration.


Something that has an effect outside the liver, for example when viral hepatitis affects the kidneys or causes depression.


Red-coloured, oxygen-carrying chemical in red blood cells.

  • Vasculitis: a painful blood circulation disorder.
  • Autoimmune thyroid disease.
  • Autoimmune hepatitis: this is a more serious form of liver disease than viral infection.
  • Glomerulonephritis: a serious form of kidney disease in which the blood filtering function becomes impaired.
  • Polyarthritis: multiple joint pains and swelling.
  • Cryoglobulinaemia: a condition in which abnormal proteins called cryoglobulins form in the blood.
  • Porphyria cutanea tarda: a condition in which by-products of haemoglobin production build up in the body.
  • Scleroderma: hardening of the skin.
  • Sicca syndrome: a chronic condition characterised by dry eyes and dry mouth.

HCV infects the lymphatic system as well as the liver and the blood. Nearly all people with hepatitis C have virus in their lymphatic vessels and organs. Hepatitis C has also been linked to low blood cell counts and to diabetes and other metabolic disorders.

This information was originally adapted from Hepatitis C: Understanding a silent killer, published by the European Liver Patients Association. It was updated in 2016.


  1. Cacoub P et al. Extrahepatic manifestations of chronic hepatitis C. MULTIVIRC Group. Multidepartment Virus C. Arthritis Rheum 42: 2204-2212, 1999
  2. Ferri C et al. HCV-related autoimmune and neoplastic disorders: the HCV syndrome. Dig Liver Dis 39 (Suppl 1):S13-S21, 2007
  3. Carta MG et al. Association of chronic hepatitis C with major depressive disorders: irrespective of interferon-alpha therapy. Clin Pract Epidemol Ment Health 3: 22, 2007
  4. Zignego AL et al. Extrahepatic manifestations of Hepatitis C Virus infection: a general overview and guidelines for a clinical approach. Dig Liver Dis 39: 2-17, 2007