Impact of DAA-Based Regimens on HCV-Related Extra-Hepatic Damage: A Narrative Review
Two-third of patients with chronic hepatitis C show extrahepatic manifestations due to HCV infection of B lymphocytes, such as mixed cryoglobulinemia and non-Hodgkin B-cell lymphoma, or develop a chronic inflammatory status that may favor the development
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Impact of DAA-Based Regimens on HCV-Related Extra-Hepatic Damage: A Narrative Review Evangelista Sagnelli, Caterina Sagnelli, Antonio Russo, Mariantonietta Pisaturo, Clarissa Camaioni, Roberta Astorri, and Nicola Coppola Abstract
Two-third of patients with chronic hepatitis C show extrahepatic manifestations due to HCV infection of B lymphocytes, such as mixed cryoglobulinemia and non-Hodgkin B-cell lymphoma, or develop a chronic inflammatory status that may favor the development of adverse cardiovascular events, kidney diseases or metabolic abnormalities. DAAs treatments induce HCV eradication in 95% of treated patients, which also improves the clinical course of extrahepatic manifestations, but with some limitations. After HCV eradication a good compensation of T2DM has been observed, but doubts persist about the possibility of obtaining a stable reduction in fasting glucose and HbA1c levels. Chronic HCV infection is associated with low total and LDL cholesterol serum levels, which however increase significantly after HCV elimination, possibly due to the disruption of HCV/lipid metabolism interaction. Despite this adverse effect, HCV eradication exerts a favorable action on cardiovascular system, possibly by eliminating numerous E. Sagnelli (*), C. Sagnelli, A. Russo, M. Pisaturo, C. Camaioni, R. Astorri, and N. Coppola Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy e-mail: [email protected]
other harmful effects exerted by HCV on this system. DAA treatment is also indicated for the treatment of patients with mixed cryoglobulinemia syndrome, since HCV eradication results in symptom reduction and, in particular, is effective in cryoglobulinemic vasculitis. Furthermore, HCV eradication exerts a favorable action on HCV-related lymphoproliferative disorders, with frequent remission or reduction of clinical manifestations. There is also evidence that HCV clearance may improve impaired renal functions, but same conflicting data persist on the effect of some DAAs on eGFR. Keyword
HCV extrahepatic manifestations · Hepatitis C virus · Interferon-free DAA regimens
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Introduction
Hepatitis C virus (HCV) infection is a major cause of chronic liver disease worldwide. Chronic HCV infection tends to progress towards liver fibrosis and cirrhosis and subsequently to hepatocellular carcinoma (HCC) in the context of bridging fibrosis or liver cirrhosis (Stroffolini et al. 2018; Sagnelli et al. 2013, 2019).
E. Sagnelli et al.
In 2015, 71 million people were living with chronic HCV infection worldwide (Global Hepatitis Report 2017). Exposure to infected blood or blood products (intravenous drug use, iatrogenic exposure, tattooing, piercing) and risky sexual contact (multiple partners, anal sex, presence of genital lesions) were the risk factors most frequently associated with the transmission of this infection (Santantonio et al. 2006; Corey et al. 2006; Daniels et al. 2009; Esteban et al. 2008). After becoming infected with HCV, almost 35% of the subjects
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