Rosenthal E, Cacoub P
Service de Médecine Interne, Hôpital de l'Archet, CHU de Nice, Nice; Université de Nice-Sophia Antipolis, Nice, France COREVIH PACA EST, CHU de Nice, France
Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France INSERM, UMR_S 959, Paris, France CNRS, FRE3632, Paris, France AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France.
Lupus. 2015 Apr;24(4-5):469-82. doi: 10.1177/0961203314556140.
Patients with chronic hepatitis C virus (HCV) infection frequently present with extrahepatic manifestations covering a large spectrum, involving different organ systems leading to the concept of systemic HCV infection. These manifestations include autoimmune phenomena and frank autoimmune and/or rheumatic diseases and may dominate the course of chronic HCV infection. Chronic HCV infection causes liver inflammation affecting the development of hepatic diseases. HCV is also a lymphotropic virus that triggers B cells and promotes favorable conditions for B lymphocyte proliferation, including mixed cryoglobulinemia (MC) and MC vasculitis, which is the most prominent extrahepatic manifestation of chronic HCV infection. HCV may also promote a low-grade chronic systemic inflammation that may affect the development of some extrahepatic manifestations, particularly cardiovascular and cerebral vascular diseases. Recognition of extrahepatic symptoms of HCV infection could facilitate early diagnosis and treatment. The development of direct-acting antiviral agents (DDAs) has revolutionized HCV treatment. DDAs, as well as new B-cell-depleting or B-cell-modulating monoclonal antibodies, will expand the panorama of treatment options for HCV-related extrahepatic manifestations including cryoglobulinemic vasculitis. In this context, a proactive, integrated approach to HCV therapy should maximize the benefits of HCV therapy, even when liver disease is mild.
慢性丙型肝炎病毒（HCV）感染患者常常出现范围广泛的肝外表现，累及不同器官系统，由此引出了全身性HCV感染的概念。这些表现包括自身免疫现象以及明确的自身免疫性和/或风湿性疾病，且可能主导慢性HCV感染的病程。慢性HCV感染会引发肝脏炎症，影响肝脏疾病的发展。HCV还是一种嗜淋巴细胞病毒，可触发B细胞并为B淋巴细胞增殖创造有利条件，包括混合性冷球蛋白血症（MC）和MC血管炎，这是慢性HCV感染最突出的肝外表现。HCV还可能引发低度慢性全身性炎症，这可能影响某些肝外表现的发展，尤其是心血管和脑血管疾病。认识HCV感染的肝外症状有助于早期诊断和治疗。直接抗病毒药物（DDA）的出现彻底改变了HCV的治疗方式。DDA以及新型的B细胞清除或B细胞调节单克隆抗体，将拓宽包括冷球蛋白血症性血管炎在内的HCV相关肝外表现的治疗选择范围。在此背景下，即使肝脏疾病较轻，积极、综合的HCV治疗方法也应能使HCV治疗的益处最大化。
