Abstract
Hepatitis C virus (HCV) infects 180 million people worldwide and over 4 million people in the United States. HCV infection is a major cause of chronic liver disease and is recognized as a risk factor for clinical cardiovascular disease (CVD). Many studies have shown increased prevalence of cardiac and inflammatory biomarkers in patients with chronic HCV infection (CHC), and though these markers may be used to risk stratify people for cardiac disease in the general population their role in the HCV population is unknown. Patients with CHC have elevated cardiac and inflammatory biomarkers compared to noninfected controls which may play a role in CVD risk stratification. We undertook a systematic review of inflammatory and cardiac biomarkers in people with HCV infection with a focus on the effect of CHC on serum levels of these markers and their utility as predictors of CVD in this population. Medline, EMBASE, and Cochrane databases were searched for relevant articles until June 2019. A total of 2430 results were reviewed with 115 studies included. Our review revealed that HCV infection significantly alters serum levels of markers of inflammation, endothelial function, and cardiac dysfunction prior to HCV treatment, and some of which may change in response to HCV therapy. Current risk stratification tools for development of CVD in the general population may not account for the increased inflammatory markers that appear to be elevated among HCV‐infected patients contributing to increased CVD risk.
Highlights
Hepatitis C virus (HCV) is a single stranded RNA virus belonging to the Flaviviridae family
We conducted a search based on PRISMA guidelines[10] on Medline, EMBASE, and Cochrane for English language articles published through 14 June, 2019 using the following keywords and mesh terms: Hepatitis C, HCV, hepacivirus, chronic hepatitis C, inflammatory biomarkers, biomarkers and inflammation, biomarkers and inflammation mediators, cardiac biomarker, C-reactive protein, CRP, high sensitivity C-reactive protein, high-sensitivity CRP (hsCRP), interluekin-6, tumor necrosis factor-alpha, troponin T, troponin I, brain natriuretic peptide, Brain natriuretic peptide (BNP), pro B-type natriuretic peptide, N-terminal pro b-type natriuretic peptide, NT-proBNP cardiovascular diseases, coronary disease, heart failure
We found that the preponderance of data suggested that HCV infection significantly alters serum levels of markers of inflammation, endothelial function, and cardiac dysfunction prior to HCV treatment, and some of which may change in response to HCV therapy
Summary
Hepatitis C virus (HCV) is a single stranded RNA virus belonging to the Flaviviridae family. In 2016, over 2 million Americans had an opioid use disorder with 10% to 20% of those escalating to injection drug use.[3] In this setting the prevalence of HCV has dramatically increased, especially in younger patients, with injection drug use (IDU) being the primary mode of transmission in the US and a 2-fold increase in the incidence rate of acute HCV infection.[4]. Studies have shown increased prevalence of certain cardiac biomarkers associated with increased CVD risk in patients with CHC compared to age-matched uninfected patients.[8]. Some of these biomarkers are combined with traditional risk factors to risk stratify persons for cardiac disease in the general population,[9] but their utility in setting of HCV infection is unknown. We aim to review the current literature on inflammatory and cardiac biomarkers in patients with HCV infection with a focus on the effect of CHC on serum levels of these markers and their utility as predictors of CVD in this population
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