Autonomic evaluation of hepatitis C virus infected patients

Abstract

Hepatitis C virus (HCV) affects 170 million people all over the world. In Brazil, the incidence of HCV-infected individuals is 5.1/100,000 habitants. The highest prevalence is seen in Acre State, in the Brazilian Amazon (22.7/100,000 habitants) 1 . HCVinfection has been associated with neurological manifestations, including peripheral neuropathy. Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and distal sensory polyneuropathy have been reported. HCV-infection associated with central nervous system vasculitis was also referred. About 65% of infected patients are around 30 to 49 years old of age, and 30% will develop hepatocellular carcinoma. The physiopathology basis is still unknown 2 . It seems that there is no direct tissues lesion by the virus, but probably an immune response against the virus could develop the disease. There are few reports focusing the relation between the HCV and dysautonomia [3][4][5][6][7] . Our objective was to report the autonomic cardiovascular function in HCVinfected Brazilian patients with sensory small-fiber neuropathy. METHODSWe have included 12 consecutive HCV-infected patients with sensory small-fiber polyneuropathy. Patients were randomly selected from a cohort of more than 60 HCV patients followed in the Hepatitis Reference Center (Dr. Bordalo) of Hospital Universitário Antônio Pedro, Niterói, Rio de Janeiro, Brazil. Patients with diabetes, arterial hypertension, severe liver dysfunction, other infections, including HIV and HTLV, use of ABSTRACTThere are few studies reporting the association between hepatitis C virus (HCV) infection and disautonomia. We have evaluated the autonomic cardiovascular function in 12 patients with sensory small-fiber polyneuropathy infected by HCV. The mean age was 49±13 years old. The mean infection time was 9.6 years in six (50%) patients. Thermal and pinprick hypoesthesia was observed in distal legs in all patients. Autonomic symptoms were referred by eight (66.7%) patients. Among patients with abnormal autonomic cardiovascular test, five (41.7%) showed abnormal results in two or more tests. Valsalva maneuver was abnormal in seven (58.3%) patients. We can consider that there is an association of both parasympathetic and sympathetic efferent cardiovascular dysfunction in this group of patients.Key words: hepatitis C, dysautonomia, small-fiber polyneuropathy. RESUMOExistem poucos estudos que relatam a associação entre infecção pelo vírus da hepatite C (HCV) e disautonomia. Avaliamos a função autonômica cardiovascular em 12 pacientes com polineuropatia de fibras finas e infectados pelo HCV. A idade média foi de 49±13 anos. O tempo de infecção média foi de 9,6 anos em seis (50%) pacientes. Hipoestesia termoalgésica foi observada nos segmentos distais das pernas em todos os pacientes. Sintomas autonômicos foram relatados por oito (66,7%) pacientes. No teste autonômico cardiovascular, cinco (41,7%) apresentaram resultados anormais em dois ou mais testes. Manobra de Valsalva foi anormal em sete (58,3%) pacientes. Podemos considerar qu...

Cardiac autonomic neuropathy: The hidden cardiovascular comorbidity in elderly patients with chronic obstructive pulmonary disease attending primary care settings

“…The diagnosis of chronic liver disease was determined by self‐reported history of hepatitis B or C viral infection, or jaundice, ascites, and confirmed by abnormal liver function tests and/or abdominal ultrasound. The presence of hepatitis C viral infection itself was reported to be associated with CAN …”

Hepatitis C virus and human T-cell lymphotropic virus type 1 co-infection: impact on liver disease, virological markers, and neurological outcomes

“…18 Involvement of the central nervous system (CNS), 19,20 the peripheral nervous system (PNS), 21 and less frequently the autonomic nervous system, has also been documented, either as a direct manifestation of the infection or as a paraneoplastic presentation in cases of HCC. 22 HCV/HTLV-1 co-infection may be common, particularly in countries where these viruses are endemic, since they share similar modes of transmission. This is especially true in certain population groups, such as in persons who have unprotected sex habits, intravenous drug users (IDU), and individuals with a history of blood transfusion.…”

Diagnostic value of blood tests for occult causes of initially idiopathic small-fiber polyneuropathy

“…Sensory and autonomic-predominant polyneuropathies are linked to abnormal blood-test results for diabetes [69], alcohol-related liver dysfunction [5], heavy-metal toxicity [36], deficiencies of vitamins B12 (cobalamin) and B1 (folate) [33, 60], hypothyroidism and hyperthyroidism [1, 47], paraproteinemia [74], sarcoidosis [24], and systemic autoimmune disorders including Sjögren’s syndrome (SS) [49, 55], systemic lupus erythematosus [46], and celiac [6, 8, 64]. Infectious causes include human immunodeficiency virus [62], hepatitis C [10], leprosy [38], and Lyme disease [25]. Rare genetic variants underlie some familial and sporadic cases, with a Dutch SFPN cohort reporting 2.3% prevalence of SCN9A sodium-channel mutations [51].…”