Rheumatologic manifestations of hepatitis C in the era of direct-acting antiviral agents

Priora, Marta; Realmuto, Cristina; Parisi, Simone; Ditto, Maria Chiara; Borrelli, Richard; Peroni, Clara Lisa; Laganà, Angela; Fusaro, Enrico

doi:10.23736/s1121-421x.20.02680-x

Cited by 6 publications

(6 citation statements)

References 79 publications

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“…Tissue damages, either directly by viruses or as a result of immune aggressions against infected cells, result in the release of a large number of tissue antigens. Additionally, it has been previously postulated that similarities between HCV antigens and host antigens are partly responsible for the development of ANA and anti-smooth muscle antibodies (ASMA)[ 141 ]. RF was detected in 70% of patients, followed by ANA (20 to 40%), anticardiolipin antibodies (15%), antithyroid antibodies (12%), and ASMA (7%)[ 140 ].…”

Section: Extrahepatic Manifestations Of Chronic Hepatitis C Virus Inf...mentioning

confidence: 99%

“…DAAs reduce the viral load and therefore decrease the production of antibodies. The eradication of HCV with DAAs supports improving the articular manifestations[ 141 ]. SOF and DCV with or without ribavirin combination therapy are an effective and safe treatment with minimal side effects for eradication of HCV infection and amelioration of HCV related RM[ 143 , 144 ].…”

Section: Extrahepatic Manifestations Of Chronic Hepatitis C Virus Inf...mentioning

confidence: 99%

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Impact of direct-acting antiviral regimens on hepatic and extrahepatic manifestations of hepatitis C virus infection

Salama¹,

Raslan²,

Abdel‐Latif³

et al. 2022

WJH

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Hepatitis C virus (HCV) is a common cause of liver disease and is associated with various extrahepatic manifestations (EHMs). This mini-review outlines the currently available treatments for HCV infection and their prognostic effect on hepatic manifestations and EHMs. Direct-acting antiviral (DAA) regimens are considered pan-genotypic as they achieve a sustained virological response (SVR) > 85% after 12 wk through all the major HCV genotypes, with high percentages of SVR even in advanced fibrosis and cirrhosis. The risk factors for DAA failure include old males, cirrhosis, and the presence of resistance-associated substitutions (RAS) in the region targeted by the received DAAs. The effectiveness of DAA regimens is reduced in HCV genotype 3 with baseline RAS like A30K, Y93H, and P53del. Moreover, the European Association for the Study of the Liver recommended the identification of baseline RAS for HCV genotype 1a. The higher rate of hepatocellular carcinoma (HCC) after DAA therapy may be related to the fact that DAA regimens are offered to patients with advanced liver fibrosis and cirrhosis, where interferon was contraindicated to those patients. The change in the growth of pre-existing subclinical, undetectable HCC upon DAA treatment might be also a cause. Furthermore, after DAA therapy, the T cell-dependent immune response is much weaker upon HCV clearance, and the down-regulation of TNF-α or the elevated neutrophil to lymphocyte ratio might increase the risk of HCC. DAAs can result in reactivation of hepatitis B virus (HBV) in HCV co-infected patients. DAAs are effective in treating HCV-associated mixed cryoglobulinemia, with clinical and immunological responses, and have rapid and high effectiveness in thrombocytopenia. DAAs improve insulin resistance in 90% of patients, increase glomerular filtration rate, and decrease proteinuria, hematuria and articular manifestations. HCV clearance by DAAs allows a significant improvement in atherosclerosis and metabolic and immunological conditions, with a reduction of major cardiovascular events. They also improve physical function, fatigue, cognitive impairment, and quality of life. Early therapeutic approach with DAAs is recommended as it cure many of the EHMs that are still in a reversible stage and can prevent others that can develop due to delayed treatment.

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Section: Extrahepatic Manifestations Of Chronic Hepatitis C Virus Inf...mentioning

confidence: 99%

Section: Extrahepatic Manifestations Of Chronic Hepatitis C Virus Inf...mentioning

confidence: 99%

Impact of direct-acting antiviral regimens on hepatic and extrahepatic manifestations of hepatitis C virus infection

Salama¹,

Raslan²,

Abdel‐Latif³

et al. 2022

WJH

View full text Add to dashboard Cite

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“…The persistent viral stimulation allows for a polyclonal expansion of B-cells [ 7 , 8 ] to be performed therefore causing the appearance of immune-complexes [ 9 ] which can cause a wide spectrum of autoimmune and lymphoproliferative disorders; these conditions can either be clinical, merely serological or both [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Autoantibodies and Rheumatologic Manifestations in Hepatitis C Virus Infection

Priora¹,

Borrelli

Parisi

et al. 2021

Biology

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HCV is a virus that can cause chronic infection which can result in a systemic disease that may include many rheumatologic manifestations such as arthritis, myalgia, sicca syndrome, cryoglobulinemia vasculitis as well as other non-rheumatological disorders (renal failure, onco-haematological malignancies). In this population, the high frequency of rheumatoid factor (45–70%), antinuclear (10–40%) and anticardiolipin (15–20%) antibodies is a B-cell mediated finding sustained by the infection. However, the possibility that a primitive rheumatic pathology may coexist with the HCV infection is not to be excluded thus complicating a differential diagnosis between primitive and HCV-related disorders.

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“…Многогранное воздействие персистирующего в организме вируса лежит в основе системного воспаления низкой интенсивности (англ. LGSI -low grade systemic inflammation), которое постепенно развивается и находит свое подтверждение у всех больных с хронической виремией RNA HCV [15][16][17][18].…”

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Virological failures of primary interferon-free therapy in patients with chronic HCV RNA viremia and successful repeated interferon-free therapy

Sulima¹,

Sulejmanova

Yakovlev

et al. 2022

VIČ-infekc. immunosupr.

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Objective. Description of clinical forms of chronic HCV infection in the observed patients, clarifications of options and causes of virological failures of primary interferon-free therapy (DAAT/1) and the results of repeated interferon-free treatment (DAAT/2).Materials and methods. 8 patients with chronic RNA HCV viremia (subtypes 1b+/–1a and 3а/3ab) were prospectively observed who suffered a virological failure of primary interferon-free therapy with original inhibitors in the form of relapse of RNA HCV viremia and aviremic low-level replication RNA HCV in PBMCs (peripheral mononuclears), but then achieved HCV eradication with a repeated course of interferon-free therapy.Results. Two variants of virological failures of primary interferon-free therapy were noted — relapse of RNA HCV viremia and aviremic low-level replication of RNA HCV in PBMCs. A number of unfavorable prognosis signs (individual clinical and laboratory syndromes and laboratory parameters) were revealed, which were observed in most patients who did not achieve HCV eradication using primary interferon-free therapy with antiviral drugs: HCV-associated syndromes of low-grade systemic inflammation (LGSI), benign lymphoproliferation and autoantibody production, a high level viral load of HCV RNA viral load in blood plasma, HBV-coinfection without HBsAg and cirrhosis of the liver in the outcome of chronic hepatitis C. The target result of repeated interferon-free therapy, confirmed by the sustainable virological response after 12 weeks after the end of the treatment (SVR12), was achieved in all «losers» of primary interferon-free therapy.Conclusion. The unfavorable prognostic signs identified in the majority of «losers» of primary interferon-free therapy in the form of individual clinical and laboratory syndromes and laboratory parameters may be associated with potential virological inefficiency of therapy. Based on logistic regression analysis, the value of each of the identified features for predicting different outcomes of primary interferon-free therapy in a large group of patients with HCV is shown. Pangenotypic combinations of GLE/PIB+SOF+/–RBV and VEL/SOF+RBV inhibitors have shown their high antiviral efficacy in the treatment of relapse of RNA HCV viremia and aviremic low-level replication of RNA HCV in peripheral mononuclears for all the patients for whom primary interferon-free therapy was unsuccessful.

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Rheumatologic manifestations of hepatitis C in the era of direct-acting antiviral agents

Cited by 6 publications

References 79 publications

Impact of direct-acting antiviral regimens on hepatic and extrahepatic manifestations of hepatitis C virus infection

Impact of direct-acting antiviral regimens on hepatic and extrahepatic manifestations of hepatitis C virus infection

Autoantibodies and Rheumatologic Manifestations in Hepatitis C Virus Infection

Virological failures of primary interferon-free therapy in patients with chronic HCV RNA viremia and successful repeated interferon-free therapy

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