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      For patients with rheumatic disease and hepatitis C infection: the end of interferon

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      Author(s): 1 , 2 , 3 , 4 , 5
      Publication date (Electronic):
      Journal: RMD Open
      Publisher: BMJ Publishing Group
      Keywords: Infections, Autoimmunity, Treatment

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          Abstract

          Hepatitis C virus (HCV) is a global pathogen and is the cause of rare but complex rheumatic complications but more commonly exists as a challenging comorbidity for patients with existing rheumatic diseases. Until recently, the standard of care of HCV has been the use of interferon-based regimens, which not only have limited effectiveness in curing the underlying viral illness but are poorly tolerated and in patients with rheumatic diseases especially problematic given their association with a wide variety of autoimmune toxicities. Numerous and other more effective and better tolerated regimens are rapidly emerging incorporating direct acting antiviral agents that do not require the use of interferon, that is, interferon free. The potential of interferon free treatment of HCV makes screening for this comorbidity more important than ever. Rheumatologists need to be knowledgeable about these therapeutic advances and partner with hepatologists to craft the most efficacious and toxicity-free regimes possible.

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          Most cited references20

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          Understanding the hepatitis C virus life cycle paves the way for highly effective therapies.

          Troels Scheel, Charles Rice (2013)
          More than two decades of intense research has provided a detailed understanding of hepatitis C virus (HCV), which chronically infects 2% of the world's population. This effort has paved the way for the development of antiviral compounds to spare patients from life-threatening liver disease. An exciting new era in HCV therapy dawned with the recent approval of two viral protease inhibitors, used in combination with pegylated interferon-α and ribavirin; however, this is just the beginning. Multiple classes of antivirals with distinct targets promise highly efficient combinations, and interferon-free regimens with short treatment duration and fewer side effects are the future of HCV therapy. Ongoing and future trials will determine the best antiviral combinations and whether the current seemingly rich pipeline is sufficient for successful treatment of all patients in the face of major challenges, such as HCV diversity, viral resistance, the influence of host genetics, advanced liver disease and other co-morbidities.
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            Global control of hepatitis C: where challenge meets opportunity.

            L. Thomas (2013)
            We are entering an important new chapter in the story of hepatitis C virus (HCV) infection. There are clear challenges and opportunities. On the one hand, new HCV infections are still occurring, and an estimated 185 million people are or have previously been infected worldwide. Most HCV-infected persons are unaware of their status yet are at risk for life-threatening diseases such as cirrhosis and hepatocellular carcinoma (HCC), whose incidences are predicted to rise in the coming decade. On the other hand, new HCV infections can be prevented, and those that have already occurred can be detected and treated--viral eradication is even possible. How the story ends will largely be determined by the extent to which these rapidly advancing opportunities overcome the growing challenges and by the vigor of the public health response.
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              Extrahepatic manifestations of chronic hepatitis C. MULTIVIRC Group. Multidepartment Virus C.

              P Cacoub, T Poynard, P Ghillani … (1999)
              To assess the prevalence of clinical and biologic extrahepatic manifestations of hepatitis C virus (HCV) infection and to identify associations between clinical and biologic manifestations. To analyze the natural history of extrahepatic manifestations of HCV infection, we reviewed only the data recorded prospectively during the first visit of 1,614 patients with chronic HCV infection, coming from a single monocenter cohort. Exclusion criteria were positivity for hepatitis B surface antigen or human immunodeficiency virus. The prevalence of dermatologic, rheumatologic, neurologic, and nephrologic manifestations; diabetes; arterial hypertension; autoantibodies; and cryoglobulins were assessed. Then, using multivariate analysis, we identified demographic, biochemical, immunologic, virologic, and liver histologic factors associated with the presence of extrahepatic manifestations. At least 1 clinical extrahepatic manifestation was observed in each of 1,202 patients (74%). Five manifestations had a prevalence >10%: arthralgia (23%), paresthesia (17%), myalgia (15%), pruritus (15%), and sicca syndrome (11%). Four biologic abnormalities had a prevalence >5%: cryoglobulins (40%), antinuclear antibodies (10%), low thyroxine level (10%), and anti-smooth muscle antibodies (7%). Only vasculitis, arterial hypertension, purpura, lichen planus, arthralgia, and low thyroxine level were associated with cryoglobulin positivity. By univariate and multivariate analyses, the most frequent risk factors for the presence of clinical and biologic extrahepatic manifestations were age, female sex, and extensive liver fibrosis. Extrahepatic clinical manifestations are frequently observed in HCV patients and involve primarily the joints, muscles, and skin. The most frequent immunologic abnormalities include mixed cryoglobulins, antinuclear antibodies, and anti-smooth muscle antibodies. The most frequent risk factors for the presence of clinical and biologic extrahepatic manifestations are advanced age, female sex, and extensive liver fibrosis.
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                Author and article information

                Journal
                Journal ID (nlm-ta): RMD Open
                Journal ID (iso-abbrev): RMD Open
                Journal ID (hwp): rmdopen
                Journal ID (publisher-id): rmdopen
                Title: RMD Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2056-5933
                Publication date Collection: 2015
                Publication date (Electronic): 18 February 2015
                Volume: 1
                Issue: 1
                Electronic Location Identifier: e000008
                Affiliations
                [1 ]Cleveland Clinic Lerner, College of Medicine of Case Western Reserve University, RJ Fasenmyer Chair of Clinical Immunology, Cleveland Clinic, Cleveland, Ohio, USA
                [2 ]Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ Paris 06, UMR 7211 , Paris, France
                [3 ]INSERM, UMR_S 959 , Paris, France
                [4 ]CNRS, FRE3632 , Paris, France
                [5 ]Department of Internal Medicine and Clinical Immunology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière , Paris, France
                Author notes
                [Correspondence to ] Professor Leonard H Calabrese; calabrl@ 123456ccf.org
                Article
                Publisher ID: rmdopen-2014-000008
                DOI: 10.1136/rmdopen-2014-000008
                PMC ID: 4613164
                PubMed ID: 26509045
                SO-VID: 14f34639-2003-471c-9dc5-acd023728f4e
                Copyright © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date received : 21 October 2014
                Date accepted : 7 December 2014
                Categories
                Subject: 1506
                Subject: Infectious Diseases
                Series title: Viewpoint

                Keywords: infections,autoimmunity,treatment
                Data availability:
                Keywords: infections, autoimmunity, treatment

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