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Metabolic aspects of hepatitis C virus
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Download the PDF here
Download the PDF here
Download the PDF here
El-Kassas M, Awad A. World J Gastroenterol 2022
Abstract
Many metabolic factors are associated with chronic hepatitis C virus (HCV) infection and can influence the course of the illness and impact the progression of liver and non-liver-related diseases through complex interactions. Several of these factors impact the course of chronic HCV (CHC) and result in the conceptual translation of CHC from a localized to systemic disease. Besides the traditional liver manifestations associated with CHC infection, such as cirrhosis and hepatocellular carcinoma, various extrahepatic disorders are associated with HCV infection, including atherosclerosis, glucose and lipid metabolic disturbances, alterations in the iron metabolic pathways, and lymphoproliferative diseases. The coexistence of metabolic disorders and CHC is known to influence the chronicity and virulence of HCV and accelerates the progression to liver fibrosis and hepatocellular carcinoma. Insulin resistance is one of the key factors that have a tremendous metabolic impact on CHC. Therefore, there is a great need to properly evaluate patients with CHC infection and correct the modifiable metabolic risk factors. Furthermore, patients with HCV who achieved a sustained virological response showed an overall improvement in glucose metabolism, but the exact evidence still requires further studies with long-term follow-up. This review delineates the most recent evidence on the main metabolic factors associated with CHC and the possible influence of chronic HCV infection on metabolic features.
"The eradication of HCV remains an essential target for preventing the progression of liver disease and improving or preventing HCV-related metabolic extrahepatic manifestations that have an essential role in morbidity and mortality, affecting the patient’s health-related quality of life.
In individuals with CHC, hepatic steatosis is a frequent histological finding, with a frequency of up to 80%, which is higher than that in noninfected individuals; thus, it is considered as a distinct entity in the setting of HCV viral infection with specific clinical and prognostic implications[35,36]. Not only viral factors are responsible for steatosis in patients with CHC, but there are also different common risk factors for steatosis, such as obesity, T2D, alcohol, and dyslipidemia, which are common in the examined cohorts[5].....steatosis has also been related to HCV viral load and was found to decrease after SVR was achieved[35]....Many studies reported that steatosis could be a predictor of liver fibrosis in patients with CHC; additionally, in untreated CHC patients, worsening of steatosis may be an independent factor related with the advancement of liver fibrosis. This could be explained by "viral" and "metabolic" steatosis, in which elevated insulin levels and inflammatory mediators on liver stellate cells promote the advancement of fibrosis and liver disease[10,38]"
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