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Cardiovascular Involvement in Chronic Hepatitis C Virus Infections - Insight from Novel Antiviral Therapies
Wolfgang Poller1,2, Arash Haghikia1,2, Mario Kasner1
1Department of Cardiology, CC11 Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Insights
Hepatitis C virus (HCV) infection is linked to cardiomyopathy, but a causal link is unproven. New interferon-free treatments offer a chance to study HCV
Area of Science:
- Hepatology
- Cardiology
- Virology
Background:
- A statistical association between Hepatitis C Virus (HCV) infection and cardiomyopathy is recognized, but a causal relationship remains unestablished.
- Interferon (IFN)-based treatments for HCV are poorly tolerated by advanced heart failure (HF) patients, limiting research into HCV's role in cardiac dysfunction.
- HCV infection can affect various organs through immune and autoimmune pathways, raising concerns about its impact on cardiac health.
Purpose of the Study:
- To investigate the causal relationship between Hepatitis C Virus (HCV) infection and cardiac dysfunction.
- To evaluate the role of novel, well-tolerated, interferon-free direct-acting antiviral (DAA) regimens in studying HCV's impact on the heart.
- To determine the frequency and clinical relevance of unexplained heart failure in patients with chronic HCV infection.
Main Methods:
- Utilizing new direct-acting antiviral (DAA) agents that are highly virus-specific and lack cardiac side effects.
- Planning a large-scale study to determine the frequency of unexplained heart failure in chronic HCV infection.
- Initiating a prospective study to assess the benefit of HCV eradication in affected patients.
Main Results:
- The development of highly efficient and well-tolerated IFN-free anti-HCV regimens provides a novel approach to investigate the HCV-cardiomyopathy link.
- DAA agents offer a unique opportunity to study the specific role of HCV in cardiac dysfunction without confounding cardiac side effects.
- A planned large-scale study will quantify the prevalence of unexplained heart failure in chronic HCV infection.
Conclusions:
- Novel DAA therapies enable definitive investigation into the cause-effect relationship between HCV and cardiac dysfunction.
- Understanding the impact of HCV on cardiac health is crucial given the high global prevalence of chronic infection.
- Future studies will address the clinical significance and potential benefits of HCV eradication for cardiac outcomes.
Abstract:
Whereas statistical association of hepatitis C virus (HCV) infection with cardiomyopathy is long known, establishment of a causal relationship has not been achieved so far. Patients with advanced heart failure (HF) are mostly unable to tolerate interferon (IFN)-based treatment, resulting in limited experience regarding the possible pathogenic role of HCV in this patient group. HCV infection often triggers disease in a broad spectrum of extrahepatic organs, with innate immune and autoimmune pathogenic processes involved. The fact that worldwide more than 70 million patients are chronically infected with HCV illustrates the possible clinical impact arising if cardiomyopathies were induced or aggravated by HCV, resulting in progressive HF or severe arrhythmias. A novel path has been opened to finally resolve the long-standing question of cause-effect relationship between HCV infection and cardiac dysfunction, by the recent development of IFN-free, highly efficient, and well tolerable anti-HCV regimens. The new direct-acting antiviral (DAA) agents are highly virus-specific and lack unspecific side-effects upon cardiac function which have always confounded the interpretation of IFN treatment data. The actual frequency of unexplained HF in chronic HCV infection will be determined from a planned large-scale study. Whereas such patients probably constitute a rather small fraction of all those harboring HCV, they have major clinical relevance. It is not yet known which fraction of these patients will significantly benefit from HCV eradication, but this issue will be addressed now in a prospective study.
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