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Published on: July 16, 2012
Uncommon immune-mediated extrahepatic manifestations of HCV infection
Ciro Romano1, Giovanna Cuomo1, Roberta Ferrara1
1a Division of Internal Medicine, Department of Medical and Surgical Sciences , "Luigi Vanvitelli" University of Campania , Naples , Italy.
Insights
Chronic hepatitis C virus (HCV) infection can cause many immune-related conditions outside the liver. New direct-acting antiviral agents offer a cure, potentially resolving these HCV-related extrahepatic manifestations.
Area of Science:
- Hepatology and Immunology
- Virology
- Rheumatology
Background:
- Chronic hepatitis C virus (HCV) infection is linked to diverse extrahepatic manifestations driven by immune dysregulation.
- Mixed cryoglobulinemia is a well-known immune-mediated complication, but less common manifestations also exist.
- These include rheumatologic, dermatologic, ophthalmologic, renal, pulmonary, hematologic, cardiovascular, and neuropsychiatric conditions.
Purpose of the Study:
- To review less common extrahepatic manifestations of HCV infection.
- To discuss their presumed immune pathogenesis.
- To evaluate the role of new oral direct-acting antiviral agents (DAAs) in their management.
Main Methods:
- Literature review of extrahepatic manifestations associated with chronic HCV infection.
- Analysis of the immunological pathways involved.
- Assessment of the impact of novel antiviral therapies.
Main Results:
- HCV-induced immune responses can lead to a wide spectrum of clinical presentations beyond liver disease.
- Pathogenesis is multifactorial, involving various immune mechanisms.
- Direct-acting antiviral agents achieve high cure rates for HCV infection.
Conclusions:
- Etiologic treatment with DAAs is crucial to halt immune-driven hepatic and extrahepatic abnormalities.
- Cure of HCV infection with modern antiviral therapies is expected to significantly reduce or eliminate these extrahepatic complications.
- HCV-related extrahepatic manifestations may cease to be a significant comorbidity following successful antiviral treatment.
Introduction:
Chronic hepatitis C virus (HCV) infection has been associated with myriad extrahepatic manifestations, often resulting from aberrant immune responses. Among the most common immune-mediated manifestations of HCV infection, mixed cryoglobulinemia is the best known extra-hepatic complication. Areas covered: Here we review less common extrahepatic manifestations of HCV infection, with ascertained or presumed immune pathogenesis and the role of the new all oral direct-acting antiviral agents. Rheumatologic, dermatologic, ophthalmologic, renal, pulmonary, hematologic, cardiovascular, and neuropsychiatric manifestations of HCV infection have been considered. Expert commentary: Pathogenesis of HCV-induced aberrant immune responses resulting in peculiar clinical manifestations is not restricted to a single mechanism. A sound approach would therefore consider implementation of an etiologic treatment, through use of antiviral medications, to stop upstream in the pathogenic process all the immune mechanisms leading to hepatic and extrahepatic abnormalities. With the recent introduction of interferon-free, direct antiviral agents, capable of warranting cure for nearly all HCV-infected patients subjected to therapy, both common and uncommon extrahepatic manifestations of chronic hepatitis C are expected to no longer constitute a matter of comorbidity in the course of HCV infection.
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