The Push to Inform the Many Dangerous Effects of HCV

JANUARY 19, 2018
Gail Connor Roche
Tina Broder, MSW, MPHTina Broder, MSW, MPH
As many as three-quarters of individuals with hepatitis C (HCV) experience disorders related to the virus beyond the impact on their livers, the National Viral Hepatitis Roundtable estimates.

HCV-related kidney disease, depression, skin disorders, lymphoma and other conditions can seriously impact a patient, even without severe damage to the liver, studies have shown. There’s also growing evidence as to how HCV intersects with other disease states, Tina Broder, MSW, MPH, Program Director of NVHR, told MD Magazine.

 “Our hope in highlighting the extrahepatic manifestations of HCV is to show that curing HCV patients may help improve health conditions beyond liver function,” Broder said.

To publicize that point, NVHR is creating a campaign aimed at both clinicians and patients that emphasizes the importance of managing the virus as a system-wide condition. The group is distributing informational “fact sheets” produced from a review of scientific research and input from staff and a clinical consultant with expertise in HCV. The aim is to help make a business case for treating patients regardless of the severity of their liver disease and to broaden treatment access, Broder said.
           
As many as 3.9 million people in the US have chronic HCV, the US Centers for Disease Control and Prevention (CDC) estimates. Of every 100 individuals infected with the virus, 75 to 85 of them will develop chronic HCV. Five to 20 of these patients will progress to cirrhosis in 20 to 30 years. As many as 5 will die from cirrhosis or liver cancer, the CDC estimates.
           
Hepatitis C-related effects on parts of the body besides the liver can be an early indicator of HCV infection, NVHR says. And the virus may be driving other chronic conditions that primary care providers must spend their time managing.
           
“The evidence showing that HCV infection is a risk factor for other health conditions continues to grow,” Broder said. “Concurrently, research is beginning to show that in the era of direct acting antivirals (DAAs), early HCV treatment can cure and possibly prevent the development of extrahepatic manifestations associated with HCV.”

One of the virus’s most serious non-liver manifestations is mixed cryoglobulinemia (MC) vasculitis, a condition is characterized by a buildup in the blood of abnormal proteins, called cryoglobulins, which result from the body’s immune response to the presence of HCV.
           
“Over time, this leads to inflammation of blood vessels and disruption of blood flow to various parts of the body,” Broder said.
           
About 20% to 30% of individuals with MC vasculitis will experience kidney disease. As many as 10% will develop B-cell non-Hodgkin’s lymphoma, a cancer of the immune system. If not detected early, these conditions can be fatal. 
           
HCV also is associated with rare health conditions. Porphyria cutanea tarda is a skin disorder that results in painful lesions, abnormal hair growth, or changes in skin color. Sicca syndrome, which causes dryness of the eyes and mouth, is another uncommon HCV-related condition, Broder said.
           
“Perhaps more surprising is that HCV is also associated with common health conditions such as diabetes, cardiovascular disease, and depression,” she said. “HCV-infected individuals are at increased risk for these conditions compared to the general population.”
           
HCV patients with these chronic comorbidities are more likely to have poor health outcomes. A recent meta-analysis suggests that patients infected with hepatitis C are almost twice as likely to die from cardiovascular disease than those without the infection. 
           
“This highlights the importance of recognizing HCV as a disease that affects the entire body and understanding the role of HCV in a patient’s overall health,” Broder said.
           
NVHR will host a webinar in the spring featuring clinical experts and a patient perspective on the topic.

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