Extra-hepatic Morbidity and Mortality of Chronic Hepatitis C

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

Risultato della ricerca: Articlepeer review

205 Citazioni (Scopus)

Abstract

Chronic hepatitis C virus (HCV) infection is associated with several extra-hepaticmanifestations. Patients with HCV may develop mixed cryoglobulinemia and its sequelae,ranging from cutaneous and visceral vasculitis to glomerulonephritis and B cell non-Hodgkin’slymphoma. HCV-infected patients have increased rates of insulin resistance, diabetes andatherosclerosis, which may lead to increased cardiovascular morbidity and mortality. Neurologicmanifestations of HCV infection include fatigue and cognitive impairment. The mechanismscausing the extra-hepatic effects of HCV infection are likely multifactorial and may includeendocrine effects, HCV replication in extra-hepatic cells, or a heightened immune reaction withsystemic effects. Successful eradication of HCV with interferon alpha and ribavirin was shown toimprove some of these extra-hepatic effects: sustained virologic response is associated withresolution of complications of cryoglobulinemia, reduced levels of insulin resistance, reducedincidence of diabetes and stroke, and improved fatigue and cognitive functioning. Theavailability of new interferon-free, well-tolerated anti-HCV treatment regimens is broadening thespectrum of patients available for therapy, including those in whom interferon wascontraindicated, and will likely result in greater improvements in the extra-hepatic manifestationsof HCV. If these regimens are shown to confer significant benefit in the metabolic,cardiovascular, or neuropsychiatric conditions associated with HCV infection, extra-hepaticmanifestations of HCV may become a major indication for treatment even in the absence of liverdisease.
Lingua originaleEnglish
pagine (da-a)1345-1360
Numero di pagine16
RivistaGastroenterology
Volume149
Stato di pubblicazionePublished - 2015

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

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