Abstract
Extrahepatic manifestations are a feature of chronic hepatitis C virus (HCV) infection. In the course of chronic HCV infection, about 70% of patients have one or more extrahepatic manifestations. The latter are often the first and only clinical sign of infection. Experimental and clinical data support a causal association for many extrahepatic manifestations and HCV infection, which include mixed cryoglobulinemia, non-Hodgkin lymphomas (NHL), cardiovascular disease, insulin resistance, type 2 diabetes, neurological and psychiatric disease and other rheumatic diseases. All these extrahepatic conditions influence the morbidity, quality of life and mortality of HCV-infected patients. Currently, interferon-free therapeutic regimens with direct-acting antiviral agents (DAA) offer the possibility of treatment to almost the entire infected population, irrespective of stage of cirrhosis and associated serious comorbidities, always maintaining a high efficacy and tolerability. Several studies have shown a close association between HCV clearance by DAAs and an improvement or reduction in the risk of extrahepatic manifestations. Patients with HCV after a sustained virologic response (SVR) by DAA treatment have a lower risk than non-responders of developing cryoglobulinemic vasculitis and B-cell non-Hodgkin’s lymphomas. Furthermore, the SVR by DAA also reduces the risk of acute coronary syndrome, cardiovascular disease, insulin resistance and type 2 diabetes, and it improves atherosclerosis. HCV clearance by DAA also improves the quality of life and survival of patients with chronic HCV infection with associated extrahepatic diseases. Thus, DAAs should be initiated as early as possible in HCV patients with extrahepatic manifestations.
Highlights
It has recently been estimated that 71.1 million people are infected with the hepatitisC virus (HCV) worldwide, with an annual incidence of 1.75 million [1]
In the management of patients with chronic hepatitis C virus (HCV) infection, it is necessary to consider a correct strategy for the prevention and control of extrahepatic manifestations that have an important impact on both mortality and health costs
The recent introduction of new IFN-free direct-acting antiviral agents (DAA) treatments that are safe and highly effective in eradicating HCV in about 100% of cases has basically changed the prognosis of these patients
Summary
Cesare Mazzaro 1, * , Luca Quartuccio 2 , Luigi Elio Adinolfi 3 , Dario Roccatello 4 , Gabriele Pozzato 5 , Riccardo Nevola 3 , Maurizio Tonizzo 6 , Stefano Gitto 7 , Pietro Andreone 8 and Valter Gattei 1. Virus Infection and the Impact of Direct-Acting Antiviral Therapy. Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations
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