Oral manifestations in patients with chronic hepatitis C

Abstract

Background: Hepatitis C virus (HCV) infection, a systemic disease characterized by extrahepatic manifestations (EMs), affects approximately 50 million people worldwide. Recognizing EMs, which may involve multiple organs and systems, is crucial for timely diagnosis and effective antiviral therapy. Purpose of the study was to investigate extrahepatic symptoms occurring in the oral mucosa in HCV-infected patients.

Methods: The observational study included 153 consecutive patients with chronic hepatitis C and healthy controls. Data collection encompassed demographic parameters, medical history, laboratory results, and oral examinations, which included evaluation of dry mouth, pain and burning in the mouth and on the tongue, pain in the angles of the mouth, bad breath, gingival bleeding, dysphagia and taste disorders using scales designed for this purpose, clinical and dental examination.

Results: Subjective oral symptoms were twice as common in the study group as in controls with the most frequent dry mouth, followed by oral pain, and burning in the mouth. Pathological changes (oral candidiasis, angular cheilitis and lichen planus), were identified in 73.2% of patients, compared to 32% in the control group. Oral hygiene was worse in the study group with a median score of 1.8 compared to 1.1 as assessed by the Oral Hygiene Index scale. The incidence of Mikulicz's aphthae, papillomas, fibromas and sublingual varices did not reach statistically significant differences. The study group had fewer teeth with dental fillings. Additionally, age ≥ 40 years and GT1 infection were identified as independent predictors of oral pathologies in HCV-infected patients.

Conclusions: In patients with chronic HCV infection, oral mucosal pathologies were significantly more common compared to controls, with candidiasis, angular cheilitis, and oral lichen planus being the most frequently observed conditions. Subjective symptoms such as dry mouth, oral pain, and burning were also markedly higher in the HCV group. Age ≥ 40 years and GT1b HCV genotype were identified as independent positive predictors of oral mucosal lesions.

Keywords: Chronic hepatitis C; Extrahepatic manifestations; Hepatitis C virus; Oral lichen planus; Oral pathologies.

Fig. 1

Flow chart of patient selection for the studied population. HBV: Hepatitis B virus; HCV: Hepatitis C virus; HIV: Human immunodeficiency virus

Fig. 2

Comparison of mouth dryness severity according to the Challacombe scale in the study and control groups

Fig. 3

Candidiasis of the tongue in a 42-year-old man with chronic hepatitis C. Copyright Joanna Gałuszka-Garnuszek

Fig. 4

Angular cheilitis in a 47-year-old man with chronic hepatitis C. Copyright Joanna Gałuszka-Garnuszek

Fig. 5

Wilson's Lichen Planus—reticular form on the buccal mucosa in an 81-year-old man with chronic hepatitis C. Copyright Joanna Gałuszka-Garnuszek

Fig. 6

Sublingual varices in a 71-year-old female with chronic hepatitis C. Copyright Joanna Gałuszka-Garnuszek

Fig. 7

Comparison of patients with HCV infection with and without pathological changes based on genotype, degree of liver fibrosis, HCV RNA levels, ALT, BMI, and gender. A Patients with pathological changes. B Patients without pathological changes. Low HCV RNA—< 800,000 IU/mL. High HCV RNA- ≥ 800,000 IU/mL. ULN for females- 35 IU/L. ULN for males- 50 IU/L. ALT: Alanine aminotransferase; BMI: Body mass index; F: Female; F0-F4: Degree of liver fibrosis; GT: Genotype; M: Male; RNA: Ribonucleic acid; ULN: Upper limit of normal

Fig. 8

Comparison of patients with HCV infection with and without lichen planus (A), with and without angular cheilitis (B), with and without candidiasis (C) and mouth dryness severity according to the Challacombe scale based on genotype, degree of liver fibrosis, HCV RNA levels, ALT, BMI, and gender. Low HCV RNA—< 800,000 IU/mL. High HCV RNA- ≥ 800,000 IU/mL. ULN for females- 35 IU/L. ULN for males- 50 IU/L. ALT: Alanine aminotransferase; BMI: Boddy mass index; F: Female; F0-F4: Degree of liver fibrosis; GT1b: Genotype 1b; M: Male; non-GT1b: Non-Genotype 1b; RNA: Ribonucleic acid; ULN: Upper limit of normal