Extrahepatic Manifestations of Chronic HCV Infection- A Comp
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An estimated 71 million people worldwide have chronic hepatitis C virus (HCV) infection. Chronic infection with HCV, a hepatotropic virus, is known for morbidity mainly involving liver complications (cirrhosis and hepatocellular carcinoma), with an estimated 350,000 liver-related deaths per year. Among all viruses, hepatotropic and nonhepatotropic, HCV is recognized as the virus most often associated with extrahepatic manifestations. Although a large proportion of patients are asymptomatic, up to two thirds present with such manifestations.

A discussion of the numerous pathophysiological mechanisms underlying these extrahepatic manifestations are summarized. Unequivocal data support a causal relationship between chronic HCV infection and some of these disorders, including cryoglobulinemic vasculitis, lymphoma, cardiovascular diseases, insulin resistance, and type 2 diabetes, all of which can substantially affect morbidity, mortality, and quality of life.

The introduction of interferon-alfa–free antiviral regimens that are safe and effective has transformed the prognosis for patients with HCV infection. Studies have shown an association between direct-acting antiviral therapy and a reduction in both the incidence and severity of extrahepatic manifestations of HCV infection. On the one hand, we should keep in mind the low level of evidence from such studies, most of which have been retrospective and some of which have lacked a competitive risk analysis for status with respect to liver fibrosis.

On the other hand, the epidemiologic data are strengthened by a close association between HCV clearance and the resolution of some extrahepatic manifestations of HCV. The fact that the majority of patients receiving direct-acting antiviral agents can be cured of HCV infection, with a benefit at the extrahepatic level, reinforces the recommendation that all patients with HCV infection should receive direct-acting antiviral therapy.

In developing countries, unfortunately, universal availability of direct-acting antiviral agents is not the rule today. It is therefore important to determine whether extrahepatic manifestations could still be a health problem in these countries. Although HCV eradication is still far from a reality in developing countries, physicians should be aware of the benefits of these agents in improving hepatic and extrahepatic outcomes.

Source: https://www.nejm.org/doi/full/10.1056/NEJMra2033539?query=featured_home
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