title: Impact of hepatitis C virus therapy on metabolism and public health.
abstract: Chronic hepatitis C virus (HCV) is associated with insulin resistance (IR) and leads to type 2 diabetes mellitus (T2DM) and hepatic steatosis in many patients. These metabolic complications of HCV have been shown to accelerate the progression of fibrosis to cirrhosis and increase the risk of hepatocellular carcinoma. The metabolic syndrome is a common disorder that also includes IR, T2DM and hepatic steatosis. Approximately 20%-30% of patients with chronic HCV also have co-existent metabolic syndrome. The cause of steatosis in patients with the features of both the metabolic syndrome and chronic HCV is sometime difficult to determine. Patients with metabolic syndrome and chronic HCV are also at risk of developing renal, cardiovascular and cerebrovascular disease. Recent data suggest that HCV is an independent risk factor for renal, coronary and cerebral vascular disease, and may increase mortality associated with these disorders. The treatment of HCV can now result in a sustained virological response and cure nearly all patients with chronic HCV. The eradication of HCV reduces the risk of developing IR and T2DM, improves IR and 2TDM, reduces the risk of developing chronic kidney disease, end-stage renal disease, acute cardiac syndrome and stroke in patients with 2TDM. Thus, treatment of chronic HCV can provide a significant public health benefit, but only if all patients with chronic HCV are identified and universally treated.
authors.affiliation: Liver Institute of Virginia, Bon Secours Health System, Richmond and Newport News, VA, USA.
authors.forename: Mitchell L
authors.initials: ML
authors.lastname: Shiffman
authors.affiliation: Liver Institute of Virginia, Bon Secours Health System, Richmond and Newport News, VA, USA.
authors.forename: Nadege T
authors.initials: NT
authors.lastname: Gunn
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D002561:Cerebrovascular Disorders / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D018450:Disease Progression; D005234:Fatty Liver / Q000150:complications; D016174:Hepacivirus; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D007333:Insulin Resistance; D007676:Kidney Failure, Chronic / Q000150:complications; D008103:Liver Cirrhosis / Q000150:complications; D024821:Metabolic Syndrome / Q000150:complications* / Q000453:epidemiology; D011634:Public Health; D012307:Risk Factors
chemical_list: D000998:Antiviral Agents
keywords: hepatitis C virus; insulin resistance; metabolic syndrome; type 2 diabetes mellitus