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Metabolic and cardiovascular complications after virological cure in hepatitis C: What awaits beyond

Mohamed Shengir1, Mohamed Elgara2, Giada Sebastiani3

  • 1Department of Medicine, McGill University, Montreal, Quebec H3A0G4, Canada.

World Journal of Gastroenterology
|May 19, 2021
PubMed

Insights

Chronic hepatitis C (CHC) cure can improve metabolic issues like insulin resistance and diabetes mellitus. However, sustained virologic response (SVR) may increase cardiovascular disease risk due to lipid profile changes.

Area of Science:

  • Hepatology
  • Cardiology
  • Infectious Diseases

Background:

  • Chronic hepatitis C (CHC) is linked to extrahepatic manifestations (EHMs), including cardiometabolic diseases.
  • Mechanisms of CHC-induced EHMs and the impact of antiviral therapy are under investigation.
  • Data on EHMs after sustained virologic response (SVR) remain conflicting.

Purpose of the Study:

  • To review current knowledge on EHMs following CHC virological cure.
  • To summarize the effects of SVR on cardiometabolic diseases and cardiovascular risk.
  • To inform clinical practice regarding CHC sequelae post-SVR.

Main Methods:

  • Literature review of studies examining CHC, EHMs, and SVR.
  • Synthesis of data on cardiometabolic alterations and cardiovascular disease (CVD) events post-cure.
  • Analysis of factors influencing EHM outcomes after viral eradication.

Main Results:

  • Successful CHC treatment (SVR) can reverse hepatic steatosis and hypocholesterolemia, potentially leading to an unfavorable lipid profile and increased CVD risk.
  • Metabolic alterations like insulin resistance and diabetes mellitus (DM) often show some reduction post-SVR, with variations depending on HCV genotype.
  • Interferon-based and direct-acting antiviral therapies may reduce DM incidence.
  • Epidemiological studies on SVR and CVD show mixed results, but predominantly suggest decreased CVD events in patients achieving SVR compared to non-responders.

Conclusions:

  • CHC cure impacts EHMs, with both beneficial effects on metabolic parameters and potential risks for cardiovascular health.
  • Understanding these post-SVR sequelae is crucial for managing patients and mitigating long-term health consequences.
  • Further research is needed to reconcile conflicting data and refine clinical management strategies.

Keywords:
Cardiovascular diseaseChronic hepatitis CDiabetes mellitusHepatic steatosisSustained virologic response

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