Clinical outcomes in chronic hepatitis C long-term responders to pre-direct antiviral agents: a single-center retrospective study

Abstract

Background. Obesity, type 2 diabetes (T2D), dyslipidemia, arterial hypertension as well as hepatic steatosis (HS) are common conditions that can affect clinical outcomes of patients with chronic hepatitis C (CHC) who achieved sustained virological response (SVR). The aim of this study was to assess the impact of metabolic cofactors on the occurrence of clinical events during follow-up (FU) in a group of CHC long term responders (LTRs) to interferon (IFN)-based therapy. Methods. A total of 5172 medical records of CHC patients enrolled from 1990 to 2011 were examined. 1034/5172 (20%) patients were treated with IFN-based therapy and 382/1034 (37%) of them achieved SVR. A total of 188 (49%) LTRs performed liver biopsy before antiviral treatment. Data on liver and cardiometabolic events such as cirrhosis and its complications, hepatocellular carcinoma, coronary artery disease, arterial hypertension, impaired fasting glucose (IFG)/type 2 diabetes (T2D) and dyslipidemia, were collected over time. Results. The mean age of the whole cohort was 46 ± 12 years and 114/188 (61%) patients were males. HS was found in 82/188 (43.6%) patients and most of them were infected by HCV genotype 3a. The prevalence of obesity, IFG/T2D, dyslipidemia and arterial hypertension was 4.3%, 6.9%, 37.2% and 5.9%, and was similarly distributed among patients with and without HS. Cirrhosis was histologically diagnosed in 18/188 (9.6%) patients. After a median follow-up of 11 years (range 3-21), the cumulative incidence of cardiovascular events, IFG/T2D and dyslipidemia was higher in CHC-LTRs who had HS at baseline compared to those without HS (1.2%, 2.3% and 3.0% vs 0.4%; 0.8% and 2.5%, respectively). At multivariable Cox regression analysis, HS was significantly associated to the development of cardiovascular events and IFG/T2D (HR=5.2, 95%CI=1.3-20.7, p=0.019 and HR=2.6, 95%CI=1.1-6.2, p=0.027, respectively). Conclusions. In CHC-LTRs, HS at baseline may predispose to the development of cardiovascular events and T2D during follow-up emphasizing the importance of an accurate counseling in order to prevent extra-hepatic complications.

Impact of direct-acting antiviral regimens on hepatic and extrahepatic manifestations of hepatitis C virus infection

“…HCV can also infect and replicate in other cell types, such as peripheral blood mononuclear cells (PBMCs) and bone marrow cells through cell-to-cell transmission[ 22 ]. HCV infects PBMCs and other cells through the interaction with CD81 molecules on the cell surface[ 23 ], allowing replication of HCV in the extrahepatic tissues, which is facilitated by the expression of miR-122[ 24 ]. B lymphocytes, particularly CD27+ memory B cells, can resist apoptosis and may serve as an HCV reservoir[ 25 ].…”

Current management of NAFLD/NASH

“…Before the NAFLD epidemic, the most frequently identified liver diseases worldwide were chronic hepatitis B and C 13 . Patients with hepatitis C and a sustained virological response with steatosis present worse extrahepatic outcomes such as cardiovascular events and T2DM 14 …”

Hepatitis C virus infection and atherosclerotic cardiovascular disease: recent knowledge, further insights

“…It would be interesting if Piekarska et al could provide us with the patients' co-morbidities, mainly diabetes mellitus, chronic kidney disease, hypertension and obesity, as they might have an impact on their results [1]. Another recently published retrospective analysis demonstrated that the presence of hepatic steatosis in a large cohort of patients with chronic HCV infection increased almost 4-fold the risk of development of cardiovascular disease (HR: 5.2, 95% CI: 1.3-20.7), emphasizing the importance of timely and targeted counselling and multilevel assessment of these patients [8]. In the study by Piekarska et al, 4 patients with chronic HCV infection and concomitant CAD exhibited hepatic fibrosis; however, no data on hepatic steatosis are provided [1].…”