Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2018; 24(41): 4617-4621
Published online Nov 7, 2018. doi: 10.3748/wjg.v24.i41.4617
Chronic hepatitis C, atherosclerosis and cardiovascular disease: What impact of direct-acting antiviral treatments?
Luigi Elio Adinolfi, Luca Rinaldi, Riccardo Nevola
Luigi Elio Adinolfi, Luca Rinaldi, Riccardo Nevola, Department of Medical, Surgical, Neurological, Metabolic, and Geriatric Sciences, University of Campania “L. Vanvitelli”, Naples 80138, Italy
Author contributions: Adinolfi LE conceived the editorial; all authors equally contributed to the realization of the editorial.
Conflict-of-interest statement: The authors state that they do not have any conflict of interest to declare.
Open-Access: 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/
Correspondence to: Luigi Elio Adinolfi, MD, Full Professor, Department of Medical, Surgical, Neurological, Metabolic, and Geriatric Sciences, University of Campania “L. Vanvitelli”, Piazza Miraglia, Naples 80138, Italy. luigielio.adinolfi@unicampania.it
Telephone: +39-81-5665081
Received: August 18, 2018
Peer-review started: August 19, 2018
First decision: October 9, 2018
Revised: October 11, 2018
Accepted: October 21, 2018
Article in press: October 21, 2018
Published online: November 7, 2018

Hepatitis C virus (HCV) infection is associated with extrahepatic manifestations, among these there is an increased risk of atherosclerosis and cardiovascular disease as well as an increased cardiovascular mortality. Several direct and indirect HCV pro-atherogenic mechanisms have been proposed. HCV lives and replicates within carotid plaques, promoting a local environment of pro-atherogenic factors. In addition, it causes conditions such as insulin resistance, diabetes, hepatic steatosis, cryoglobulinemia and endotoxinemia that are associated with the development of atherosclerosis and cardiovascular disease. Therapeutic regimens based on direct-acting antiviral agents (DAA) are currently available with high efficacy in HCV clearance and improvement of liver disease, but does HCV eradication also improve atherosclerosis and the risk of cardiovascular disease? Recently, a multi-center study has shown that elimination of HCV improves carotid atherosclerosis. Two studies have shown that DAA treatments significantly reduce the risk of cardiovascular events. Several studies have assessed the impact of HCV clearance on pro-atherosclerosis metabolic conditions showing improvement in cardiovascular risk biomarkers, disappearance or improvement of insulin resistance, reduction of risk of developing diabetes and improvement of glycemic control. There are also evidences that HCV clearance promotes the recovery of cytokines and inflammatory markers associated with atherosclerosis and the disappearance of cryoglobulinemia. Available data show that clearance of HCV by DAAs is associated with an improvement in atherosclerosis and metabolic and immunological conditions that promote the development of cardiovascular disease. However, the data are not sufficient to allow definitive conclusions and further studies will be needed to definitively clarify the impact of HCV clearance on atherosclerosis and cardiovascular disease.

Keywords: Direct-acting antiviral agents, Hepatitis C virus, Atherosclerosis, Insulin resistance, Cardiovascular disease

Core tip: Chronic hepatitis C (HCV) infection is associated with an increased risk of atherosclerosis, cardiovascular disease and cardiovascular mortality. HCV lives within carotid plaques, promotes pro-atherogenic conditions such as pro-inflammatory cytokines, oxidative stress, insulin resistance, diabetes, steatosis, cryoglobulinemia and endotoxinemia. Direct-acting antiviral agents (DAA) are highly effective and safe therapeutic regimens. There are a number of studies showing that HCV clearance by DAAs is associated with an improvement in atherosclerosis and a reduced risk of cardiovascular events. In addition, HCV clearance is associated with improvement of metabolic and immunological conditions that promote cardiovascular disease. Further studies will be needed to confirm these promising data.