Abstract
Chronic hepatitis C virus (HCV) infection is associated with several extrahepatic manifestations. Patients with HCV may develop mixed cryoglobulinemia and its sequelae, ranging from cutaneous and visceral vasculitis to glomerulonephritis and B-cell non-Hodgkin lymphoma. HCV-infected patients have increased rates of insulin resistance, diabetes, and atherosclerosis, which may lead to increased cardiovascular morbidity and mortality. Neurological manifestations of HCV infection include fatigue and cognitive impairment. The mechanisms causing the extrahepatic effects of HCV infection are likely multifactorial and may include endocrine effects, HCV replication in extrahepatic cells, or a heightened immune reaction with systemic effects. Successful eradication of HCV with interferon alfa and ribavirin was shown to improve some of these extrahepatic effects; sustained virological response is associated with resolution of complications of cryoglobulinemia, reduced levels of insulin resistance, reduced incidence of diabetes and stroke, and improved fatigue and cognitive functioning. The availability of new interferon-free, well-tolerated anti-HCV treatment regimens is broadening the spectrum of patients available for therapy, including those in whom interferon was contraindicated, and will likely result in greater improvements in the extrahepatic manifestations of HCV. If these regimens are shown to confer significant benefit in the metabolic, cardiovascular, or neuropsychiatric conditions associated with HCV infection, extrahepatic manifestations of HCV may become a major indication for treatment even in the absence of liver disease.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1345-1360 |
| Number of pages | 16 |
| Journal | Gastroenterology |
| Volume | 149 |
| Issue number | 6 |
| DOIs | |
| State | Published - Nov 1 2015 |
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Keywords
- Cardiovascular Risk
- Cryoglobulins
- Fatigue
- Health-Related Quality of Life
- Insulin Resistance
ASJC Scopus subject areas
- Gastroenterology
Cite this
Extrahepatic Morbidity and Mortality of Chronic Hepatitis C. / Negro, Francesco; Forton, Daniel; Craxì, Antonio; Sulkowski, Mark; Feld, Jordan J.; Manns, Michael P.
In: Gastroenterology, Vol. 149, No. 6, 01.11.2015, p. 1345-1360.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Extrahepatic Morbidity and Mortality of Chronic Hepatitis C
AU - Negro, Francesco
AU - Forton, Daniel
AU - Craxì, Antonio
AU - Sulkowski, Mark
AU - Feld, Jordan J.
AU - Manns, Michael P.
PY - 2015/11/1
Y1 - 2015/11/1
N2 - Chronic hepatitis C virus (HCV) infection is associated with several extrahepatic manifestations. Patients with HCV may develop mixed cryoglobulinemia and its sequelae, ranging from cutaneous and visceral vasculitis to glomerulonephritis and B-cell non-Hodgkin lymphoma. HCV-infected patients have increased rates of insulin resistance, diabetes, and atherosclerosis, which may lead to increased cardiovascular morbidity and mortality. Neurological manifestations of HCV infection include fatigue and cognitive impairment. The mechanisms causing the extrahepatic effects of HCV infection are likely multifactorial and may include endocrine effects, HCV replication in extrahepatic cells, or a heightened immune reaction with systemic effects. Successful eradication of HCV with interferon alfa and ribavirin was shown to improve some of these extrahepatic effects; sustained virological response is associated with resolution of complications of cryoglobulinemia, reduced levels of insulin resistance, reduced incidence of diabetes and stroke, and improved fatigue and cognitive functioning. The availability of new interferon-free, well-tolerated anti-HCV treatment regimens is broadening the spectrum of patients available for therapy, including those in whom interferon was contraindicated, and will likely result in greater improvements in the extrahepatic manifestations of HCV. If these regimens are shown to confer significant benefit in the metabolic, cardiovascular, or neuropsychiatric conditions associated with HCV infection, extrahepatic manifestations of HCV may become a major indication for treatment even in the absence of liver disease.
AB - Chronic hepatitis C virus (HCV) infection is associated with several extrahepatic manifestations. Patients with HCV may develop mixed cryoglobulinemia and its sequelae, ranging from cutaneous and visceral vasculitis to glomerulonephritis and B-cell non-Hodgkin lymphoma. HCV-infected patients have increased rates of insulin resistance, diabetes, and atherosclerosis, which may lead to increased cardiovascular morbidity and mortality. Neurological manifestations of HCV infection include fatigue and cognitive impairment. The mechanisms causing the extrahepatic effects of HCV infection are likely multifactorial and may include endocrine effects, HCV replication in extrahepatic cells, or a heightened immune reaction with systemic effects. Successful eradication of HCV with interferon alfa and ribavirin was shown to improve some of these extrahepatic effects; sustained virological response is associated with resolution of complications of cryoglobulinemia, reduced levels of insulin resistance, reduced incidence of diabetes and stroke, and improved fatigue and cognitive functioning. The availability of new interferon-free, well-tolerated anti-HCV treatment regimens is broadening the spectrum of patients available for therapy, including those in whom interferon was contraindicated, and will likely result in greater improvements in the extrahepatic manifestations of HCV. If these regimens are shown to confer significant benefit in the metabolic, cardiovascular, or neuropsychiatric conditions associated with HCV infection, extrahepatic manifestations of HCV may become a major indication for treatment even in the absence of liver disease.
KW - Cardiovascular Risk
KW - Cryoglobulins
KW - Fatigue
KW - Health-Related Quality of Life
KW - Insulin Resistance
UR - http://www.scopus.com/inward/record.url?scp=84945534889&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84945534889&partnerID=8YFLogxK
U2 - 10.1053/j.gastro.2015.08.035
DO - 10.1053/j.gastro.2015.08.035
M3 - Article
C2 - 26319013
AN - SCOPUS:84945534889
VL - 149
SP - 1345
EP - 1360
JO - Gastroenterology
JF - Gastroenterology
SN - 0016-5085
IS - 6
ER -