Extrahepatic endocrine manifestations of chronic HCV infection

Chronic Hepatitis C virus (HCV) infection is associated with numerous clinically significant extrahepatic manifestations. Endocrine disorders, including thyroid diseases, insulin resistance (IR), metabolic syndrome (MetS), and diabetes mellitus (DM), are common in patients with HCV. Chronic inflammation, immune dysregulation, and direct viral effects on extrahepatic tissues contribute to the pathogenesis of these diseases. Achieving sustained virological response (SVR) with new Direct-Acting Antivirals (DAAs) has not only reduced liver-related events and improved patient outcomes but also prevented or reversed various extrahepatic endocrine disorders. However, the extent and durability of endocrine improvements vary across patient subgroups, particularly among those with advanced liver disease. Evidence indicates that some endocrine diseases persist in patients with liver cirrhosis, even after successful viral eradication. Consequently, patients diagnosed with HCV-mediated endocrine disorders, particularly those with advanced liver disease at the time of DAA initiation, require ongoing surveillance by a multidisciplinary team even after achieving HCV eradication.