Cardiovascular Involvement in Chronic Hepatitis C Virus Infections – Insight from Novel Antiviral Therapies

Abstract

Whereas statistical association of hepatitis C virus (HCV) infection with cardiomyopathy is long known, establishment of a causal relationship has not been achieved so far. Patients with advanced heart failure (HF) are mostly unable to tolerate interferon (IFN)-based treatment, resulting in limited experience regarding the possible pathogenic role of HCV in this patient group. HCV infection often triggers disease in a broad spectrum of extrahepatic organs, with innate immune and autoimmune pathogenic processes involved. The fact that worldwide more than 70 million patients are chronically infected with HCV illustrates the possible clinical impact arising if cardiomyopathies were induced or aggravated by HCV, resulting in progressive HF or severe arrhythmias. A novel path has been opened to finally resolve the long-standing question of cause-effect relationship between HCV infection and cardiac dysfunction, by the recent development of IFN-free, highly efficient, and well tolerable anti-HCV regimens. The new direct-acting antiviral (DAA) agents are highly virus-specific and lack unspecific side-effects upon cardiac function which have always confounded the interpretation of IFN treatment data. The actual frequency of unexplained HF in chronic HCV infection will be determined from a planned large-scale study. Whereas such patients probably constitute a rather small fraction of all those harboring HCV, they have major clinical relevance. It is not yet known which fraction of these patients will significantly benefit from HCV eradication, but this issue will be addressed now in a prospective study.

The Safety of The Directly Acting Antiviral Treatment For Hepatitis C Virus According To The Egyptian National Program Protocol In Patients With Midrange Ejection Fraction

“…The novel DAAs do not have the harmful effects of IFN on heart performance. Therefore, the relatively new drugs may offer a better chance for such patients to receive antiviral therapy [ 8 ].…”

“…There is no robust data for the safety of the novel DAAs used to treat chronic HCV with other comorbidities [ 8 ]. The lack of published evidence-based data on these agents’ safety in patients with cardiac dysfunction compelled the need for this study.…”

Extra Hepatic Manifestations of Viral Hepatitis A

“…Extra hepatic manifestations have been frequently described in Hepatitis B and C. Studies by Doher et al, Jaryal et al and Khaira et al describe renal manifestations, Guillain Barre syndrome and polyarteritis nodosa associated with Hepatitis B. [1][2][3] Similar studies describe cardiovascular abnormalities, cryoglobulinemia, cytopenia and even lymphoma in association with hepatitis C. 4,5 Such studies are very few in relation to hepatitis A, thus forming the basis for this study. Viral hepatitis A usually has a characteristic illness pattern consisting of mild fever, malaise, nausea, vomiting and jaundice.…”

Syndecan-1: A Review on Its Role in Heart Failure and Chronic Liver Disease Patients’ Assessment

“…Hence, a routine assessment of syndecan-1 levels in these HCV-infected patients could unmask a subclinical progression towards liver fibrosis or, more often, an early cardiac dysfunction. In a recent study, Poller et al presented some promising preliminary results regarding the positive cardiac effect exerted by the new interferon-free regimens in patients with advanced heart failure (NYHA III-IV classes) and concomitant chronic hepatitis C, with an improvement of their functional status and NYHA class [48]. Considering these findings, of equal importance, may also be the utilization of syndecan-1 in the monitoring of therapeutic effectiveness in patients with chronic hepatitis C who receive the new interferon-free therapies.…”