Extrahepatic Morbidity and Mortality of Chronic Hepatitis C

Francesco Negro, Daniel Forton, Antonio Craxì, Mark Sulkowski, Jordan J. Feld, Michael P. Manns

Research output: Contribution to journalArticle

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 languageEnglish (US)
Pages (from-to)1345-1360
Number of pages16
JournalGastroenterology
Volume149
Issue number6
DOIs
StatePublished - Nov 1 2015

Fingerprint

Chronic Hepatitis C
Hepacivirus
Morbidity
Mortality
Virus Diseases
Cryoglobulinemia
Interferons
Fatigue
Insulin Resistance
Ribavirin
B-Cell Lymphoma
Virus Replication
Glomerulonephritis
Vasculitis
Neurologic Manifestations
Interferon-alpha
Non-Hodgkin's Lymphoma
Liver Diseases
Atherosclerosis
Therapeutics

Keywords

  • Cardiovascular Risk
  • Cryoglobulins
  • Fatigue
  • Health-Related Quality of Life
  • Insulin Resistance

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Negro, F., Forton, D., Craxì, A., Sulkowski, M., Feld, J. J., & Manns, M. P. (2015). Extrahepatic Morbidity and Mortality of Chronic Hepatitis C. Gastroenterology, 149(6), 1345-1360. https://doi.org/10.1053/j.gastro.2015.08.035

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 journalArticle

Negro, F, Forton, D, Craxì, A, Sulkowski, M, Feld, JJ & Manns, MP 2015, 'Extrahepatic Morbidity and Mortality of Chronic Hepatitis C', Gastroenterology, vol. 149, no. 6, pp. 1345-1360. https://doi.org/10.1053/j.gastro.2015.08.035
Negro, Francesco ; Forton, Daniel ; Craxì, Antonio ; Sulkowski, Mark ; Feld, Jordan J. ; Manns, Michael P. / Extrahepatic Morbidity and Mortality of Chronic Hepatitis C. In: Gastroenterology. 2015 ; Vol. 149, No. 6. pp. 1345-1360.
@article{e715f5a1a3de4678a11126e31b60f7ef,
title = "Extrahepatic Morbidity and Mortality of Chronic Hepatitis C",
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.",
keywords = "Cardiovascular Risk, Cryoglobulins, Fatigue, Health-Related Quality of Life, Insulin Resistance",
author = "Francesco Negro and Daniel Forton and Antonio Crax{\`i} and Mark Sulkowski and Feld, {Jordan J.} and Manns, {Michael P.}",
year = "2015",
month = "11",
day = "1",
doi = "10.1053/j.gastro.2015.08.035",
language = "English (US)",
volume = "149",
pages = "1345--1360",
journal = "Gastroenterology",
issn = "0016-5085",
publisher = "W.B. Saunders Ltd",
number = "6",

}

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 -