Association between antiviral treatment and extrahepatic outcomes in patients with hepatitis C virus infection

Hsu, Yao Chun; Ho, H.P.; Huang, Yue; Wang, Hsi Hao; Wu, Ming Shiang; Lin, Jaw Town; Wu, Chun Ying

doi:10.1136/gutjnl-2014-308163

Cited by 200 publications

(219 citation statements)

References 44 publications

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“…SVR in patients without cirrhosis or extrahepatic advanced disease is generally associated with the resolution of liver disease and can reduce the HCV-related extra-hepatic disease burden, i.e. diabetes, kidney impairment, lymphoproliferative disorders (LPD) and cardiovascular complications, ultimately leading to an increased survival (2,3,(7)(8)(9)(10)(11)(12)(13)(14)(15). Cirrhotic patients who achieve SVR may have liver fibrosis regression, A c c e p t e d M a n u s c r i p t 6 and reduced risk of hepatic decompensation and portal hypertension complications although they maintain a residual risk of HCC (16)(17)(18)(19)(20).…”

Section: Whom To Treat?mentioning

confidence: 99%

From current status to optimization of HCV treatment: Recommendations from an expert panel

Craxı̀

Perno

Viganò

et al. 2016

Digestive and Liver Disease

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Chronic hepatitis C virus (HCV) infection is a major public health problem at a global level, causing an enormous burden of hepatic and extra-hepatic morbidity and mortality. Treatment of chronic HCV (CHC) has been revolutionized in the last few years by the introduction of highly effective and well tolerated direct acting antiviral agents (DAAs) able to achieve >90% rates of sustained virological response (SVR) in many groups of patients, including those previously excluded from interferon-based regimens. For such reason interferon-free regimens are now the treatments of choice for all patients. Successful anti-HCV treatment can stop liver disease progression and can solve the HCV-related extra hepatic manifestations, eventually reducing both liver-related and overall mortality. Together with the rapidly accumulating data about the evolution of treatment landscape, different guidelines from national and international Liver Scientific Societies have been published until today. However, these recommendations may not be applied worldwide as, due to high treatment costs, most of them identify as priority groups only patients with advanced liver disease. Moreover some types of patients pose clinical management problems for which even the guidelines do not always provide useful answers. With the aim of treatment optimization by filling some of the gaps of the current guidelines and addressing the remaining unmet needs in practice, a group of Italian experts, experienced on treatment of HCV infection, met in Stresa in February 2016. The summary of all the considerations arising from this two-day meeting and the final statements are reported in this position paper.

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Section: Whom To Treat?mentioning

confidence: 99%

From current status to optimization of HCV treatment: Recommendations from an expert panel

Craxı̀

Perno

Viganò

et al. 2016

Digestive and Liver Disease

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“…In a unique and large natural history study, Lee et al showed that patients with chronic HCV infection had a cumulative non-liver-related mortality rate of 19.8% after 18 years of follow-up, which was considerably higher as compared to those patients who cleared their HCV infection (11.0%) and those who never encountered HCV (12.2%) (2). Although not as extensively as for the cirrhosis-related complications, data are slowly emerging that achievement of SVR is also associated with a reduced occurrence of solid extra-hepatic clinical endpoints such as renal failure and cardiovascular events (3,4). These potential clinical benefits may explain the reduced occurrence of death due to extrahepatic causes in case of SVR, which Tada et al describe here.…”

Section: See Article On Page 817mentioning

confidence: 68%

Extending our confidence in sustained virological response

Maan

Meer

2016

Liver International

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“…Rates of acute coronary syndrome and ischemic stroke were significantly reduced in patients treated with peginterferon and ribavirin compared to untreated patients [39]. Although this association was found in studies originating from Far East countries, Western European and American studies, as well as a recent metaanalysis, have not established a clear correlation of HCV infection and increased cardiovascular and cerebrovascular risk [40,41]. Likewise, the pathogenetic mechanism through which HCV leads to accelerated atherosclerosis has not been fully elucidated.…”

Section: Cardiovascular Diseasementioning

confidence: 89%

Extrahepatic Manifestations of Hepatitis C Virus Infection

Jukić¹,

Kralj²

2017

Update on Hepatitis C

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Chronic hepatitis C virus (HCV) infection causes progressive liver fibrosis, cirrhosis, liver failure, and hepatocellular carcinoma. Additional to liver damage, HCV infection causes a variety of systemic disorders, some of which sometimes bear more severe morbidity than the liver disease itself. These extrahepatic manifestations represent a wide spectrum of disorders, ranging from the presence of a variety of clinically insignificant autoantibodies to diseases affecting a variety of organ systems. Mixed cryoglobulinemia is a common manifestation, and associated vasculitis can affect many organs (kidney, skin, and joints). The skin can also be affected by porphyria cutanea tarda and lichen planus. Other common extrahepatic manifestations include autoimmune disorders, lymphoproliferative disorders, and a number of neurological and neuropsychiatric disorders such as fatigue, depression, or cognitive impairment. Insulin resistance, diabetes mellitus, accelerated atherosclerosis, and increased cardiovascular disease morbidity and mortality have also been associated with chronic HCV infection. The existence and severity of extrahepatic manifestations do not correlate with the severity of liver disease, and the mainstay of treatment is HCV eradication. Patients with systemic manifestations of HCV infection should be prioritized for treatment, especially in the era of new interferon-free therapies with fewer side effects.

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Association between antiviral treatment and extrahepatic outcomes in patients with hepatitis C virus infection

Abstract: Antiviral treatment for HCV is associated with improved renal and circulatory outcomes, but unrelated to catastrophic autoimmune diseases.

Cited by 200 publications

References 44 publications

From current status to optimization of HCV treatment: Recommendations from an expert panel

From current status to optimization of HCV treatment: Recommendations from an expert panel

Extending our confidence in sustained virological response

Extrahepatic Manifestations of Hepatitis C Virus Infection

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