JLE

Hépato-Gastro & Oncologie Digestive

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Chronic Hepatitis C: hepatic and extra-hepatic expected benefits after antiviral therapy Volume 20, issue 4, Avril 2013

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Hôpital Cochin, Unité d’Hépatologie, 27 rue du Faubourg Saint Jacques, 75014 Paris, France, Université Paris Descartes, Paris, France, Inserm U.1016, Institut Cochin, Paris, France

<p>Chronic hepatitis C virus infection affects around 0.8% of French population; it results in chronic hepatitis with liver fibrosis, including cirrhosis in about 20 to 30% of patients, and in extra-hepatic manifestations.</p><p>Fibrogenesis is a dynamic process that might be enhanced by several factors (HIV or HVB infection, metabolic syndrome, alcohol abuse), and be associated with hepatic morbidity (hepatocellular carcinoma, portal hypertension, liver failure) and mortality. Extrahepatic morbidity is also enhanced (diabetes, cryoglobulinemic vasculitis, atherosclerosis, cancer), explaining the lower life expectancy of patients with chronic hepatitis C.</p><p>Antiviral therapy induces a sustained virologic response (in around 50% with pegylated interferon/ribavirin combination and in 75% with the addition of a protease inhibitor in genotype 1-infected patients and more than 90% with oral combination of direct acting antivirals) that reduces both liver-related morbidity and mortality (reduction of liver decompensation and hepatocellular carcinoma): benefits are associated with viral eradication which allows histopathological improvement, including cirrhosis reversal. Extra-hepatic improvements, particularly a reduction in the incidence of cardiovascular and cancer events, have also been reported in association with viral eradication in HIV co-infected patients.</p><p>This review aims at detailing the harmful hepatic and extra-hepatic consequences of chronic hepatitis C and the benefits expected with viral eradication following treatment.</p>