title: Metabolic alterations and chronic hepatitis C: treatment strategies.
abstract: BACKGROUND
  Chronic hepatitis C (HCV) infection is considered a metabolic disease. It is associated with a specific metabolic syndrome, HCV-associated dysmetabolic syndrome (HCADS), consisting of steatosis, hypocholesterolemia and insulin resistance/diabetes. These metabolic derangements contribute to a decrease in sustained virological response (SVR) to pegylated-interferon-α-ribavirin as standard of care (SOC), and are associated with progression of liver fibrosis.
  
  
  METHODS
  The review, highlighting the impact of HCADS and metabolic syndrome components of HCV disease progression and SOC, discusses current knowledge and perspectives on metabolic therapeutic strategies aimed at improving SVR rate of SOC for chronic hepatitis C.
  
  
  CONCLUSIONS
  HCV, features of HCADS and of metabolic syndrome may coexist in the same patient, thus all components of the metabolic syndrome must be assessed to individualize treatment. The results of therapeutic trials evaluating metabolic strategies combined with current SOC indicate that weight loss is a critical part of treatment which will improve both disease outcome and therapeutic response to SOC. Similarly, statins seem to improve response rate to SOC representing, once confirmed to be safe, an important therapeutic tool for HCV-infected patients. Findings from studies using insulin sensitizers combined with SOC are not conclusive and do not justify the use of this class of drugs in clinical practice.
authors: Second University of Naples, Internal Medicine and Hepatology, Department of Gerontology, Geriatrics and Metabolic Diseases, 80100 Naples, Italy.
authors: Luigi E
authors: LE
authors: Adinolfi
authors: Luciano
authors: L
authors: Restivo
authors: Rosa
authors: R
authors: Zampino
authors: Amedeo
authors: A
authors: Lonardo
authors: Paola
authors: P
authors: Loria
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001835:Body Weight / Q000187:drug effects; D002784:Cholesterol / Q000097:blood; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D016898:Interferon-alpha / Q000008:administration & dosage / Q000627:therapeutic use*; D024821:Metabolic Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000627:therapeutic use*; D015995:Prevalence; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D012254:Ribavirin / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; D002784:Cholesterol; C100416:peginterferon alfa-2a