Faccioli J, Nardelli S, Gioia S, Riggio O, Ridola L. Neurological and psychiatric effects of hepatitis C virus infection. World J Gastroenterol 2021; 27(29): 4846-4861 [PMID: 34447230 DOI: 10.3748/wjg.v27.i29.4846]
Corresponding Author of This Article
Lorenzo Ridola, MD, PhD, Associate Professor, Department of Translational and Precision Medicine, “Sapienza” University of Rome, viale dell’ Università, 37, Rome 00185, Italy. lorenzo.ridola@uniroma1.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is 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/
World J Gastroenterol. Aug 7, 2021; 27(29): 4846-4861 Published online Aug 7, 2021. doi: 10.3748/wjg.v27.i29.4846
Neurological and psychiatric effects of hepatitis C virus infection
Jessica Faccioli, Silvia Nardelli, Stefania Gioia, Oliviero Riggio, Lorenzo Ridola
Jessica Faccioli, Silvia Nardelli, Stefania Gioia, Oliviero Riggio, Lorenzo Ridola, Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome 00185, Italy
Author contributions: Faccioli J and Ridola L drafted the manuscript; Nardelli S, Gioia S, Riggio O and Ridola L critically reviewed the manuscript for important intellectual content; Riggio O and Ridola L approved the manuscript.
Conflict-of-interest statement: None declared.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Lorenzo Ridola, MD, PhD, Associate Professor, Department of Translational and Precision Medicine, “Sapienza” University of Rome, viale dell’ Università, 37, Rome 00185, Italy. lorenzo.ridola@uniroma1.it
Received: February 2, 2021 Peer-review started: February 2, 2021 First decision: May 1, 2021 Revised: May 7, 2021 Accepted: June 4, 2021 Article in press: June 4, 2021 Published online: August 7, 2021
Abstract
Hepatitis C virus (HCV) infection is widespread and affects 71 million people worldwide. Although hepatic manifestations are the most frequent, ranging from chronic hepatitis to cirrhosis and hepatocellular carcinoma, it is also associated with several extrahepatic manifestations. Infected patients may present non-specific neurological symptoms, regardless of the presence of liver cirrhosis. Several pathogenetic mechanisms underlying neurological symptoms have been hypothesized: neuroinvasion, immune-mediated damage, neurotransmitter alterations and cryoglobulinemia. Alterations of the central nervous system include cerebral vasculopathy, acute or subacute encephalopathy and inflammatory disorders. HCV infection may be responsible for neuropathies, of which the most frequent form is symmetrical axonal sensory or sensory-motor polyneuropathy which causes loss of leg sensitivity and weakness. Up to 50% of patients with HCV infection may experience cognitive decline and psychological disorders, such as depression and fatigue. HCV associated neurocognitive disorder is independent of the presence of liver cirrhosis and affects different domains than in patients with hepatic encephalopathy. It can be studied using specific tests that mainly explore executive functions, verbal learning and verbal recall. These disorders significantly reduce the quality of life. The new antiviral therapies improve the extrahepatic symptoms of HCV infection and their success depends on the achievement of sustained virological response. However, the effect of therapy may differ depending on the type of organ involved; neurological symptoms can be irreversible if there is organic liver damage. The aim of this review is to provide a critical overview of physiopathological mechanisms, diagnostic and therapeutic strategies of the neurological and psychiatric effects of HCV infection.
Core Tip: The aim of this review is to provide a critical overview of neurological and psychiatric disorders in patients with hepatitis C virus infection, the underlying pathogenetic mechanisms and the effect of new direct-acting antivirals on extrahepatic symptoms. The main clinical and pathogenetic differences to hepatic encephalopathy and the different diagnostic strategies used in these two conditions are reported.
