Hepatitis C comorbidities affecting the course and response to therapy

Abstract

Several studies have demonstrated that the outcome of chronic hepatitis C (CHC) infection is profoundly influenced by a variety of comorbidities. Many of these comorbidities have a significant influence on the response to antiviral therapy. These comorbidities negatively affect the course and outcome of liver disease, often reducing the chance of achieving a sustained virological response with PEGylated interferon and ribavirin treatments. Comorbidities affecting response to antiviral therapy reduce compliance and adherence to inadequate doses of therapy. The most important comorbidities affecting the course of CHC include hepatitis B virus coinfection, metabolic syndrome, and intestinal bacterial overgrowth. Comorbidities affecting the course and response to therapy include schistosomiasis, iron overload, alcohol abuse, and excessive smoking. Comorbidities affecting response to antiviral therapy include depression, anemia, cardiovascular disease, and renal failure.

Nutrition Status of Patients With Chronic Hepatitis B or C

“…1,25,26 In the current study, WC and %BF, known risk factors for cardiovascular disease, as well as IR and type 2 diabetes mellitus, were associated with being overweight/obese but not with steatosis. 1,25,26 In the current study, WC and %BF, known risk factors for cardiovascular disease, as well as IR and type 2 diabetes mellitus, were associated with being overweight/obese but not with steatosis.…”

“…1,23,25,26 Obesity and IR are critical factors in the development of NASH and the progression of liver fibrosis to cirrhosis and related complications. 1,23,25,26 Obesity and IR are critical factors in the development of NASH and the progression of liver fibrosis to cirrhosis and related complications.…”

Medication use and medical comorbidity in patients with chronic hepatitis C from a US commercial claims database

“…In addition, comorbidities that were reported previously as highly prevalent in chronic HCV patients or otherwise believed to be clinically relevant were identified for each 1-year cross-sectional cohort in either the inpatient or outpatient files using compiled ICD-9 code definitions from the medical literature (Appendix A) [17, 18]. Compensated cirrhosis was defined directly by ICD-9 code definition; advanced liver disease was a composite definition representing decompensated disease and included codes for ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, portal hypertension, esophageal varices, hepatorenal syndrome, or hepatocellular carcinoma.…”

Rolls Royce for everybody? Diagnosing liver disease by mini-laparoscopy

“…Alcohol is the most important factor determining the prognosis in hepatitis C [2], and this can best be assessed by histology. Co-morbidity due to co-existing conditions such as NASH, alpha-1 antitrypsin deficiency, iron overload, or rare co-incidences such as schistosomiasis or sarcoidosis may be detected by biopsy and have very relevant therapeutic consequences [3][4][5][6]. Thus, even in an apparently obvious liver disease, biopsy often reveals important surprises.…”