Friday, December 5, 2014

Weekend Reading: HCV Extrahepatic Manifestations - Diseases outside of the liver

Weekend Reading: HCV Extrahepatic Manifestations

Greetings from Michigan! Will you be taking time out to enjoy a few holiday festivities this weekend?

The short people and Nana are preparing to visit a man with a red suit, sure hope SC is sitting closer to the food court this year.

HCV Extrahepatic Manifestations
Today's topic is HCV related extrahepatic manifestations; diseases outside of the liver.  

The Bad News
Did you know it's estimated that over 40% of patients with chronic hepatitis C may develop at least one extrahepatic manifestation during the course of their disease?

The Good News
In order not to keep you from your weekend activities - any research highlights have been cut short, and only relevant links to easily digested  information is provided, sort of.

 Patient-Friendly Materials: Extrahepatic Manifestations of Hepatitis C
If you fall into the majority of people who don't enjoy reading a bunch of medical jargon, head over to HCV Advocate and review their "Easy C" Series on Extrahepatic Manifestations of Hepatitis C, launched just a few days ago.

Extrahepatic Manifestations (overview)

Hepatitis C-related Extrahepatic Manifestations And Symptoms  
The University of Washington offers a quick overview of; Extrahepatic Conditions Related to Hepatitis C. The following chart lists a range of  hepatitis C-related extrahepatic manifestations and symptoms.  

 Symptom/Manifestation and Potential HCV Related Syndrome 


Learn more, here.

Extrahepatic manifestations of chronic hepatitis C virus infection: 297 cases from a tertiary medical center in Beijing, China

Cheng Zhaojing, Zhou Baotong, Shi Xiaochun, Zhang Yao, Zhang Lifan, Chen Limeng and Liu Xiaoqing

For our medical nerds who love data, we begin with a large study found online in the Chinese Medical Journal 2014. The aim of the study was to determine the presence of extrahepatic manifestations in Chinese patients with chronic HCV infection. Medical records of 297 patients (mean age, 55 years; 50.8% men) were reviewed to determine the presence of the following clinical manifestations: fever, fatigue, arthralgia, Raynaud’s phenomenon, palpable purpura, renal impairment, sicca syndrome involving mouth and eyes, thyroid dysfunction, type 2 diabetes mellitus, pulmonary fibrosis, lichen planus, paresthesia, lymphoma, and cancers. Duration of infection was 14.16 years, and approximately 26% of the cohort had HCV for more than 20 years.

According to results extrahepatic manifestations (EMs) were found to be common in Chinese HCV patients, particularly fatigue, type 2 diabetes, renal impairment, lymphadenophy, fever, and thyroid dysfunction. The study found 62% of patients had at least one extrahepatic manifestation (EM), including fatigue (29.4%), diabetes mellitus (28.2%), renal involvement (12.5%), lymphadenopathy (9.6%), fever (9.4%), thyroid dysfunction (8.1%) and arthralgia (7.4%).

Older age was associated with EMs. Also noted by the researchers; Despite the high prevalence of EM, only 36.2% (194/536) patients with anti-HCV positive were seen by a specialist and a few were tested for cryoglobulin. 
Read more about the study, here. 

Hepatitis C Infection Tied to Higher Risk of Death From Non-liver Cancers
Hepatitis C has long been associated with the development of hepatocellular carcinoma, the most common type of liver cancer. In fact, HCV is the leading risk factor for HCC in the United States, and the second leading risk factor for HCC world-wide, but recently a study found people with HCV are at a higher risk for Non-liver cancers as well.

Presented at the annual meeting of the American College of Preventive Medicine this year, Reuters Health reported on; the first U.S. study to investigate and show people with chronic hepatitis C have a higher risk of death from non-Hodgkin lymphoma (NHL).  As expected, the risk of dying from liver cancer was elevated among HCV-infected patients - nearly 30 times higher than among non-infected individuals.

Cure of HCV infection reduces symptoms and mortality from severe extrahepatic manifestations
AASLD/IDSA/IAS– Guidance for Testing, Managing, and Treating Hepatitis C, offers clinical insight into the benefits of curing HCV. 

SVR is associated with more than 70% reduction in the risk of liver cancer, 90% reduction in the risk of liver-related mortality and reduces symptoms and mortality from severe extrahepatic manifestations.

Excerpt; WHEN AND IN WHOM TO INITIATE HCV THERAPY

Cure of HCV infection also reduces symptoms and mortality from severe extrahepatic manifestations, including cryoglobulinemic vasculitis, a condition affecting 10% to 15% of HCV-infected patients. (Fabrizi, 2013); (Landau, 2010) HCV-infected persons with non-Hodgkin lymphoma and other lymphoproliferative disorders achieve complete or partial remission in up to 75% of cases following successful antiviral therapy for HCV infection. (Gisbert, 2005); (Takahashi, 2012); (Svoboda, 2005); (Mazzaro, 2002); (Hermine, 2002) These reductions in disease severity contribute to dramatic reductions in all-cause mortality. (van der Meer, 2012); (Backus, 2011) Lastly, patients achieving SVR have substantially improved quality of life, which includes physical, emotional, and social health. (Neary, 1999); (Younossi, 2013) Because of the myriad benefits associated with successful HCV treatment, clinicians should treat HCV-infected patients with antiviral therapy with the goal of achieving an SVR, preferably early in the course of their chronic HCV infection before the development of severe liver disease and other complications.
Continue reading here....

Links Of Interest
Index of articles and research: 

Research
HCV Extrahepatic Mortality-kidney/heart/cancers
Extrahepatic Manifestations of Hepatitis C Virus

Remember to exercise your mind on the weekends, your body during the week and your sense of humor daily.
Tina
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