Prevalence of Oral Manifestations in Hepatitis C Virus (HCV) Infected Patients: A Systematic Review and Meta-Analysis

Abstract

Introduction: Hepatitis C virus (HCV) infection is a chronic viral disease that primarily affects the liver, potentially leading to severe complications such as cirrhosis and hepatocellular carcinoma. Early detection of HCV is challenging due to its often-asymptomatic nature, with diagnosis relying on serological tests. Extrahepatic manifestations, including oral symptoms, can aid in diagnosis and provide insights into the broader impact of the disease.

Objectives: This systematic review aims to assess the frequency of occurrence of oral manifestations in cases positive for HCV infection.

Methods: A systematic search was conducted across three databases (PubMed, EBSCO, Cochrane) from 1^st January 2000 to 31^st December 2023 to identify studies published in English that reported oral symptoms in HCV-positive patients. The review was conducted following the PRISMA guidelines, and the risk of bias was assessed using the Joanna Briggs Institute appraisal tool. Statistical analyses were performed using n Meta XL version 5.1 with 95% confidence intervals (CI) and 95% prediction intervals for future prevalence estimates.

Results: After a 2-step selection process, 17 studies were included. Overall, 1666 patients from 9 countries were assessed. Sjogren’s syndrome was the most common oral manifestation, with a pooled prevalence of 26%. The pooled prevalence for xerostomia was 23%, for recurrent aphthous ulcers was 13%, 11% for oral lichen planus, 10% for candidiasis and 7% for oral leukoplakia. Gingivitis, periodontitis, angular cheilitis and pigmentation were other reported oral manifestations in HCV positive patients.

Conclusions: Since extra hepatic manifestations of HCV are not uncommon and the disease is known to persist in a subclinical course, educating the healthcare professionals and patients regarding the same, may improve the oral healthcare and reduce the outcome related burden of the disease.