Internal Medicine, Department of Advanced Medical and Surgery Sciences, University of Campania Luigi Vanvitelli, Naples, Italy.
Expert Rev Gastroenterol Hepatol. 2021 Jun;15(6):643-656. doi: 10.1080/17474124.2021.1877136. Epub 2021 Feb 15.
Hepatitis C virus (HCV) causes a systemic infection inducing hepatic and extrahepatic diseases. These latter involve cardiovascular system, kidney, brain, endocrine, glucose, and lipid metabolism, and the immune system. HCV infection is associated with an increased risk of morbidity and mortality for both hepatic and extrahepatic events. Direct-acting antivirals (DAA), introduced in the most recent years for HCV treatment, are effective in up to 99% of cases and have changed the clinical scenarios and management of these patients.
The literature on the impact of HCV clearance by DAA on both hepatic and extrahepatic disease outcomes has been analyzed and discussed in this review in order to summarize the full therapeutic potential and its weaknesses.
Patients achieving HCV clearance have improved hepatic and extrahepatic diseases, quality of life and survival. They have lower incidence of cardiovascular disease, type 2 diabetes, kidney damage, and immuno-mediated manifestations. However, the improvements are related to the degree of pre-treatment organ damage. Therefore, a significant percentage of patients with advanced disease remains at risk of morbidity and mortality and must be monitored in the post-treatment. In addition, data emphasize the importance of starting treatment during the early stages of HCV infection.
丙型肝炎病毒（HCV）可引起全身性感染，导致肝脏和肝脏外疾病。后者涉及心血管系统、肾脏、大脑、内分泌、葡萄糖和脂质代谢以及免疫系统。HCV 感染与肝脏和肝脏外事件的发病率和死亡率增加有关。直接作用抗病毒药物（DAA）近年来被引入 HCV 治疗，在多达 99%的病例中有效，并改变了这些患者的临床情况和管理。
本文分析和讨论了 DAA 清除 HCV 对肝脏和肝脏外疾病结局的影响的文献，以总结其全面的治疗潜力和弱点。
清除 HCV 的患者的肝脏和肝脏外疾病、生活质量和生存率得到改善。他们患心血管疾病、2 型糖尿病、肾脏损害和免疫介导表现的风险较低。然而，这些改善与治疗前器官损伤的程度有关。因此，很大一部分患有晚期疾病的患者仍有发病和死亡的风险，必须在治疗后进行监测。此外，数据强调了在 HCV 感染早期开始治疗的重要性。
